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of VR1p� CITY OF PRIOR LAKE C.// Date Rec'd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT
1. Pink File PERMIT NO. 9 4g-
rNNESO TP 2. Green City /3 `
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(Ll❑ Fervevit Circe PL RI s.
LEGAL DESCRIPTION (office use only)
LOT 3 BLOCK 1 ADDITION 1/4./viec) 44/_:) PID ?57. /
OWN) R
(Phone) Cl
Name
V 'V IC y `l1 ./ `; J
V ' ( G
(Address) 4,0"' (`rr I (37 1/' lI l/ V y (vc(e R ( L? J 55
APPLICANT
(Name) Rons Mechancial Inc (Phone) 952 - 445 -8585
(Address) 2026 Colburn Drive Shakopee MN 55379
(Contact Person) Linda (Phone) 952 - 445 -8585
i l APPLICANT SIGNATURE 41(l 1 KZ DATE
4
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION _ NYREPLACEM NT ID
FURNACE MAKE AND MODEL C , ,VYL2Y MM%-O') FUEL
FLUE SIZE RETURN OPENINGS INPUT so OUTPUT 4te
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.
• echanical ❑ Radiation Fireplaces with Box Additions or
►: ' it Conditioning El 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 $ 41.5
STATE SURCHARGE $ 5.
TOTAL PERMIT FEE $ 5 4.
This Application Become 'our Building Perini� he Approved Pai i SO Receipt Not( D
O � D (3 r �1 1X
Buildi Offi . D ate D at 3 b By
uildi
g � � l� 3 S�
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372