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r RI CITY OF PRIOR LAKE 6
Date Recd
� ` Le HEATING /AIR CONDITIONING /FIREPLACE PERMIT
c3 h r
41 /ivNEso l.. 1. .
2 Pink . Yello File PERMIT NO City �� ���
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5128 Credit River Road SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER Loren Steven 612 - 709 -8848
(Name) (Phone)
(Address) 5128 Credit River Rd SE Prior Lake
APPLICANT
(Name) Ron's Mechanical Inc (Phone) 952 - 445 -8585
12010 Old Brick Yard Road Shakopee MN 55379
(Address)
(Address) (City) (Zip Code)
Y t
(Contact Person) Linda ,� (Phone) 952-445-8585
APPLICANT SIGNATURE 0.4 1 C DATE 6. . I D
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION ❑ REPLACEMENT O'ALTERATIONS
FURNACE MAKE AND MODEL F1.4�1 t.l Y I \ h Ill 1A" 4r. FUEL
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
❑ Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
[Went. System El 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 $ - f` ■ D
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ \')Q . 00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 57, v o Rece' No . (¢ / cc z-z-
Dated 3 t d B
Buildine Official Date (c
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372