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, CITY OF ORONO * 2 0 1 5 - 0 1 4 3 1 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 1U06/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3675 JACOBS MILL RD <br /> PIN : 32-118-23-24-0012 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : HEATING SYSTEMS <br /> VALUATION : $ 3,758.00 <br /> NOTE: REPLACE HEATING SYSTEM(BRYANT) <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH (VALUATION) 1.88 <br /> MN HEATING&AIR COND. MAIL-IN FEE 2.00 <br /> 10701 93RD AVE NE <br /> MAPLE GROVE, MN 55369- TOTAL 53.88 <br /> (763)424-5235 Payment(s) <br /> Minnesota State License#: BUIL-MB003270 CREDIT CARD 3130 53.88 <br /> OWNER <br /> AMENT,JEFFREY& KARI <br /> 3675 JACOBS MILL RD <br /> LONG LAKE,MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. /���? <br /> ` 1`'J�r�l� ��_� ��1.., ','._ . ,�L,C ��'� IJ,�t._L- f���-- l( � �; (�� (J, <br /> Applicant Permitee Signature � Date Issued By Signatur� Date <br />