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e l:I- ps C ITY OF PRIOR LAKE Date Rec'd
e HEATING /AIR CONDITIONING /FIREPLACE PERMIT 1//24 /(3
t Iyi
414,NEsoc-e' z. Pink File PERMIT NO .
Yellow City
3. Yellow Applicant �
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
i 'Is Wild5 PW Rice (' I P S
LEGAL DESCRIPTION (office use only) /"
LOT L /BLOCK 3 ADDITION' � C, /O /4/C PID 7 q iot6'i 0
�/� yr,
O WNER DPQ If I ( it t q,L./Z " �' � �
( Phone
(Address) ( Lf b Wdd 1 ' Y/ Ft I 0 1- i "� ) 5 37 Z
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952 445 8585
(Address) 12010 Old Brick yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) Linda (Phone) 952 4 4 5 / 8585
� 5 8 5
APPLICANT SIGNATURE _1 I fit DATE 1. J " - 'L3
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION ffriZEPLACEMENT ❑ ALTERATIONS /,,
FURNACE MAKE AND MODEL Carrier 5I MN ),q 12o FUEL N11
FLUE SIZE RETURN OPENINGS INPUT op, coo OUTPUT 115, 20
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants PLEASE NOTE: Air Conditioner
❑ St eam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water
into Required Side Yard Setbacks.
Mechanical 0 Radiation
Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices p
EVent. 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
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended )st $ Building Permit #
until June 30, 2013, _
The minimum surcharge for a [EATING PERMIT FEE $ y"q .50
"fixed fee" permit is $5.00 TATE SURCHARGE _ $ , 00 49'
OTAL PERMIT FEE $ 54.5
(Office Use Only)
This Application Become Your Building Permit When pproved Paid t / . Receipt a6
J 96
Ail A z ( Date _p By 5 3
Buildine Officia r Date lo f
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372