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O4 pRIQ� CITY OF PRIOR LAKE Date Rec'd
� 9 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� �
�j�'NES��P �. P�nk File PERMIT NO . �
2. Green City /Z .d �P
3. Yeliow Applicant � �
Please e or ' t and si at bottom
ADDRESS ZONING (oit'ice use)
I I�,./ �� I I t l I I��-� 1� 11 l.�l �� I�' �
LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
�aWNER ��� l� l��lf l, ��� (Phone � — Z' ( �J �`J��
(Address) l � �� / f 1 � �f � ( r �il I I � � �1 r ( L�J1 � � ��
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952 445 8585
(Address) 12010 Old Brick ayrds Road Shakopee MN 55379
(Address) (Ciry) (Zip Code)
(Contact Person) L i nda (Phone) 9 5 2— 4 4 5— 8 5 8 5
APPLICANT SIGNATURE � DATE g' � � �
APPLICANT PLEAS COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL V FUEL � L'1
FLUE SIZE RETURN OPENINGS INPUT �� OUTPUT (�
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
[�'Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑S'iravity ❑ Hot Water into Required Side Yard Setbacks.
[J1 Mechanical ❑ Radiation Fireplaces with Boz Additions or
�Air Conditioning ❑ Special Devices
❑Vent. System ❑ 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 Consriuction) $64.50 Residential, AC Only $49.50
�st $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended [EATING PERMIT FEE $ �•�
until June 30, 2013, TATE SURCHARGE $ .50
The minimum surcharge for a OTAL PERMIT FEE $
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid � i 1 J f`� Receipt No. ���/
'T
Date �I' �� �� By
Buildine Ofticial Date 0
24 hour notice for all inspectious (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372