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vRii CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT 3 i P 113 ;
til. kise, 411NNESO° '. Pink File PERMIT NO
2. Green City NO. 1 3 -
3. Yellollo w Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(5� Jo Pro K5I e tciv 04/ R ;O1)
LEGAL DESCRIPTION (office use only)
LOT BLOCK f ADDITION , Ly iv /)A-`— ._& 3 5 ' 1 Q 1 /44 6 46 N PID 02`36 2 O
(N ) r,I -hia Juhr6ev) (Phon 72 b 1 3
(Address) T b Dcp ) (d1 OOP 1V14 vi viol Q tE T 973
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 / A (Phone) 9 5 2 - 4 4 5 - 8 5 8 5
APPLICANT SIGNATURE i I ■, 1 ' 1 DATE ; / /--/3
c
APPLICA 4' LEA E COMPLETE BELOW
ENEW CONSTRUCTION REPLACEMENT El
FURNACE MAKE AND MODEL e FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
EWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water into Required Side Yard Setbacks.
echanical ❑ Radiation
Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
['Vent. System 111 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
ost $ Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, HEATING PERMIT FEE $ A t 4)
The minimum surcharge for a
"fixed fee" permit is $5.00 STATE SURCHARGE $ MO .50
n
TOTAL PERMIT FEE $ ltat
(Office Use Only)
This Application Becomes Your Building Permit When Approved
ZaA 5''r � (` Receipo !, I
Date B �-
Buildine Official Date `` ) I ! 3 / 41 ,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372