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PRlp CITY OF PRIOR LAKE Date Rec'd
,1,, 4 1 ,
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
,
3
���'NES�P I. le
2. Ye Pink File
City PERMIT NO.
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 0 Zq Li OTKview ore SE,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIDZZ, 2,3fQ.6
0 ((Nam i/ Y 21 m 5 ( /7 (Phone) 1 1 I'
(Address) 1 0 1 1 r vie Of J f?ior taw 17 -
..., E :37 1
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952 - 445 -8585
(Address) 12010 Old Brick Yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) Li nda (Phone) 952-445-8585
APPLICANT SIGNATURE O M • • DATE
•
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL Cox 1' etr" // "" FUEL N (.7
FLUE SIZE RETURN OPENINGS INPUT (D0 I 00D OUTPUT 551 fro -
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑ M ravity echanical ❑ Hot Water into Required Side Yard Setbacks.
[ ❑ Radiation
A ir Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended :EATING PERMIT FEE $ 1 -49.9 . 0
until June 30, 2013, STATE SURCHARGE $ 5.0 50
The minimum
permit surcharge for a
"fixed COTAL PERMIT FEE $ 5* 5
d fit is $5.00
This Application Becomes Your Building Permit When Approved Paid mil eceip , p( 9'
`l
Building Official Date Date ,AI ,i
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372