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CITY OF ORONO * Z 0 1 6 - 0 0 1 P1 9 * <br /> ^ 2750 KELLEY PARKWAY DATE ISSUED: 02/02/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3640 JACOBS MILL RD <br /> PIN : 32-118-23-24-0010 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : UNDEFINED <br /> VALUATION : $ 1,950.00 <br /> NOTE: NEW ITEMS FOR ADDITION: <br /> -[{ARD PIPE 3 RA IN LL,ADD 1 WA LL,REDO DUCT IN WORKSHOP <br /> -RELOCATE AIR EXCHANGE,VENT ONE BATH FAN <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.98 <br /> RICCAR HEATING&AIR COND INC. MAIL-IN FEE 2.00 <br /> 2387 STATION PKWY NW TOTAL 52.98 <br /> ANDOVER, MN 55304 <br /> (763)754-4000 Payment(s) <br /> Minnesota State License#:mech-MB003474 CHECK 46421 50.98 <br /> CHECK 46421 2.00 <br /> OWNER <br /> HOFFMAN,KEITH&MARY <br /> 3640 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 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 be <br /> revoked at any time for due cause. /�j� _ <br /> Iw� <br /> I' V��� ��.=� ���-'� l/��-�,�`���� 2 l "z / l U, <br /> Applicant Permitee Signature Date Issued By Signature Date � <br />