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, . CITY OF ORONO * z 0 1 z - 0 1 z z 9 * <br /> . 2750 KELLEY PARKWAY DATE ISSUED: 12/07/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4265 FOREST LAKE DR <br /> PIN : 07-117-23-12-0016 <br /> LEGAL DESC : FOREST ARMS <br /> : LOT 008 BLOCK 002 <br /> PERMIT TYPE : MECHAMCAL(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL- MULTIPLE <br /> VALUATION : $ 1,800.00 <br /> NOTE: (1)CARRIER}iEATING SYSTEM-MODEL 58STA-NATURAL GAS <br /> 4-6"FLUL-90,000 INYUT BTU'S AND 72,000 OIJTPUT BTU'S <br /> APPLICANT MECHANICAL 50.00 <br /> SABRE HEATING &AIR COND INC. STATE SURCHARGE MECH (VALUATION) 0.90 <br /> 15535 MEDINA ROAD <br /> PLYMOUTH, MN 55447 TOTAL 50.90 <br /> (763)473-2267 <br /> OWNER <br /> KALWEIT, GEORGE& KATHRINE <br /> 4265 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> l�hc work for which this pennit is issued shall be performcd 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 aran[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 whe[her or not specitied 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 arc <br /> requested in conformance with the Sta[e[3uilding Code.This permit may be <br /> revoked at any time for d e cause. <br /> � <br /> ; i <br /> � d-,.� � � � � t 2.- 2� 7 � /�-- <br /> Applicant Permite � i ature Date Iss d f3y Signature Datc <br /> SEPARATE ERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />