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r Rl CITY OF PRIOR LAKE Date Rec'd
* !, o � HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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2 . Pink File PERMIT NO. A9 /, & / 4fINNESO 2. Green City f (J
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14674 Maple Trail Se Prior lake MN 55372
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (Phone) 952- 440 -3450
(Name) Cheri Larson ( one
(Address) 14674 Maple Trail SE Prior alke MN 55372
APPLICANT 952 - 445 -8585
(Name) Rons Mechanical Inc (Phone)
(Address) 12010 Old Brick Yard Raod Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) Linda _ (Phone) 952-445-8585
/ ,
APPLICANT SIGNATURE I I A / , DATE 4- / o - / 0
APPLI • NT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
D Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity El Hot Water into Required Side Yard Setbacks.
❑ Mechanical n � h A A, Pk/ ! . Ill Radiation Fireplaces with Box Additions or
5 Air Conditioning J � �/ ❑ Special Devices Cantilevers to the Outside of Buildings
Vent. System ❑ Other Devices
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 $ 'AO
STATE SURCHARGE $ • 0 0 .50
TOTAL PERMIT FEE $ IMO
,
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Li-A_ Dat! No. o bp I
Date .7, (o Seipt
Buildine Official Date . t i f 0
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372