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F CITY OF PRIOR LAKE Date Rec'd
„e HEATING /AIR CONDITIONING /FIREPLACE PERMIT
7 �g
4f/n'NESD,P I. Pink File PERMIT NO .
2. Green City / 2, / z
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
F.Aci Du(iTrz' CRP sig qt(' ir tae S5;3fl
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(
OWNER J E5 qr ; --[` / 9 j p
(Name) `�V (Phone 1
(Address)lb DV DLI/1t1( O?Vt? V 1?ib( K 1 3 - 59 -
(Name) Ron mechanical Inc (Phone) 952- 445 -8585
(Address) 12010 Old Brick yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) Linda (Phone) 9 52— 4 4 5 — 858 5
APPLICANT SIGNATURE I' DATE
1
APPLICA T PLEAS.F, COMPLETE BELOW
❑NEW CONSTRUCTION E REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL T)r LiA,v\t 30AAV03 (koO FUEL NVl
FLUE SIZE RETURN OPENINGS INPUT 40 OUTPUT 5(p, 000
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑fefavchanical ity El ❑ Radiation Hot Water into Required Side Yard Setbacks.
Me
❑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 $ 4(4.9,4,p
STATE SURCHARGE $ . .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5-7..{ Receip o& 71 / C�
Datei i By /
Building Official Date G
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372