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HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�I�'NESD�P '. P'� F''e pERMIT NO.
2. Green City /Z . � Z
3. Yellow Applicant
lease e or ' t and si at bottom
ADDRESS ��� � �� � � � �� ^ ZONING (otFice use)
G�Cl�c�c�ad � a I�� r"1
LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
OWNER � l � � �� I �/� 1 �' (Phon�� LGC/ � ��
(Name) �
(Address)��c� � �/ � (, l,� < I r� �� I I �U� �-�I'� ,� J J��
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952-445-8585
(Address) 12010 Old Brick yard Road Shakopee MN 55379
(Address) ' (City) (Zip Code)
(Contact Person) L i nda (Phone) 9 5 2- 4 4 5- 8 5 8 5
APPLICANT SIGNATURE DATE �U " I` 2-
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION [�'�EPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL �,Q�/Y1�G ✓ ��� O�S� FUEL
FLUE SIZE RETURN OPENINGS 1NPUT OUTPUT �' •'�O�
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑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 Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ � •�
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid�� /� S � R c pt No. ��� 4
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Date � � � �
Buildine Of£cial Date '
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372