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�{ ' CITY OF ORONO * Z p� 1 3 - PJ 1 2 0 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U13/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1669 NORTH FARM RD <br /> PIN : 27-118-23-44-0008 <br /> LEGAL DESC : THE FARM AT LONG LAKE <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL-MULTIPLE <br /> VALUATION : $ 19,000.00 <br /> NOTE: (2)LENNOX NATURAL GAS HEATING SYSTEMS <br /> (2)LENNOX AIR CONDITIONING SYSTEMS <br /> APPLICANT MECHANICAL 237.50 <br /> GOLDEN VALLEY HEATING&AIR STATE SURCHARGE MECH(VALUATION) 9.50 <br /> S182 WEST BROADWAY <br /> CRYSTAL, MN 55429- MAIL-IN FEE 2.00 <br /> (612)535-2000 TOTAL 249.00 <br /> PAID WITH CC# 7420 <br /> OWNER <br /> BEENDERS& PETER MONTGOMERIE,ANTOINETTE <br /> 1669 NORTH FARM RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> I he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Statc Building Code. 'I�his permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <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 are <br /> requested in conformance with the State Building Code.This permit may bc <br /> revoked at any time for due cause. <br /> �Y11.A-t-�d.J //� �3 i /.3 �/ ,r� //i /�i /3 <br /> Applicant Permitee Signature Date Iss d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />