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� CITY OF ORONO PERMIT NO.: 201�-00047 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ►SSUE�: OU25/2011 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ' ADDRESS : 4215 FOREST LAKE DR <br /> PIN : 07-117-23-12-0026 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 004 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL - MUI.TIPLE <br /> VALUATION : $ 3,100.00 <br /> NO�I'L: I TRANE NA'1'GAS PURNACE <br /> APPLICANT <br /> MECHANICAL 50.00 <br /> ROY N. WELTER HEATING CO. STATE SURCHARGE MECH (VALUAT[ON) 5.00 <br /> 4637 CHICAGO AVE. S <br /> MINNEAPOLIS, MN 55407- MA[L-IN FEE 2.00 <br /> (612)825-6867 MISC FEE 0.00 <br /> TOTAL 57.00 <br /> OWNER PAID WITH CC# 0206 <br /> LOUGLIN,JOHN & RUTH <br /> ' 421� FORESI� LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The�a�ork 1or���hich this pennit is issued shall be perfonned according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State 13uilding Code. 7'his permit is for only the�vork described and does <br /> not brant permission for additional or related��°ork which rcquires separate <br /> permits. All provisions of laws and ordinances govemine this type of work <br /> shall be compied with whether or not specificd hercin."I'his permit will <br /> expire and become null and�oid if construction authorized is not <br /> commenced wiUiin 180 days ofthe date of issuance,or ifconstruction is <br /> suspended for a period of 180 days at any time aftcr work has commenced. <br /> The applicant is responsible 1or assuring all required inspections are <br /> requested in conlormance with the State Building Code.This pennit may be <br /> revokcd at any time 1or due cause+ <br /> ���'C-�'e �., / / l l <br /> Applicaut Permi[ee Signalure Date Issued �.ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTH R THAN DESCRIBED ABO E. <br />