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� � � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�I�'NES��� �. Pink File ���++�+++
2. Green City PERMIT NO . ' �
3. Yellow Applicant
Please or 'nt and si at bottom
ADDRESS ZONING (ott'ice use
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LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
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� (Address)�� I �� � � 1.,� I �`l1�" � � ��lJ� LWI��I.'�l_- !
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952-445-8585
(Address) � 201 0 Old Brick yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) L i n da (Phone) 9 5 2— 4 4 5— 8 5 8 5
APPLICANT SIGNATURE V��"t'�� DATE �� � AJ ' Y�
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL ,��,y�7r � r LSTPt ����� FUEL '`� V�
FLUE SIZE RETURN OPENINGS INPUT �Q��� OUTPUT _�, (�O (�
TYPE OF SYSTEM HEATING OR POWER PLANT
[�Varm Air Plants ❑ Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
[v]� echanical ❑ Radiation Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEESCHEDULE
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
�°*�m°*A� Cost $ Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGE " has been extended HEATING PERMIT FEE $ "I �
until June 30, 2013,
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildiue Official Date
24 hour notice for all inspectious (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372