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0 1 PR /0 CITY OF PRIOR LAKE '� Date Ree'd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT
U ttn
KP i. rink File t PERMIT NO
NNESO 2. Green City / ,J (/
2 - /) 7
3. Yellow Applicant
(Please type or print and sign at bottom) fold ADD S wail ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNS 121 VW I' '
(Name) (Phone) 5Z 55 " . ( 1 �'� JU
(Address)111 lirclderi viz' 71a(/ Fla La '5
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952- 445 -8585
(Address) 12010 Old Brick Yard Road Shakopee MN 55379
(Contact Person) Linda (Phone) 952 - 445 -8585
APPLICANT SIGNATURE Y N��w DATE lg 40 . rJ
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION Ly1 EPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL R,U U1) g.be loce FUEL p(',j
FLUE SIZE RETURN OPENINGS INPUT (JO ,C0 OUTPUT Fj (
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑ Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
ff ravity El Hot Water into Required Side Yard Setbacks.
M echanical ❑ Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑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
Cost $ Building Permit# .
HEATING PERMIT FEE $ *OD
STATE SURCHARGE $ TOTAL PERMIT FEE $ 4.91
This Application Becomes Your Building Permit When Approved Paid j� Receipt No. 6 9 a
Date ? ' l z B (•.-
Building Official Date b(`-' ✓ w �,c,
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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