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o � PRro f, CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
s'jNNESO 1 P File PERMIT NO. i -
2. G reen Cit
3. Yellow App licant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
rZ'L (cka 5 [t 1( Laf
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWN l4�'� I O( ft€ � sY (Phone i 9b
(Address)
: I L I - MT `S r W LJ
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 j _ (Phone) 952 4 4 5 8585
APPLICANT SIGNATURE DATE 1 a---1 a---1 r U f
APPLICANT PLEAWCOMPLETE BELOW
['NEW CONSTRUCTION n REPLACEMENT El ALTERATIONS c�
FURNACE MAKE AND MODEL 1Z � AT R h �LD (O FUEL N b]
FLUE SIZE RETURN OPENINGS INPUT v 00O OUTPUT 5410-
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 111 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 $ 149 '
STATE SURCHARGE $ •i • .50
TOTAL PERMIT FEE $ ''1�jP
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid syv Receipt No. 4 7 7/
Date r , V/2 By (7 ....7_ ■,,,,,.......,..._
Buildine Official Date •/�/�
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372