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o; VRrp CITY OF PRIOR LAKE Date Rec'd
ti 9 HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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� L Pink File PERMIT NO.
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NNEsO 2. Green City /3-1397
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5311 Bounty ST SE Prior Lake
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
��) R Howard Remit
(Phone)
952 - 334 -3759
(Address) 5311 Bounty St SE Prior lake MN 55372
APPLICANT
(Name) Rons Mechanical (Phone) 952- 445 -8585
(Address) 2026 Colburn Dr Shakopee MN 55379
(Contact Person) Linda (Phone) 952 - 445 -8585
APPLICANT SIGNATURE /k/11 (WNW DATE a-17- 13
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION PLACE T ['ALTERATIONS
FURNACE MAKE AND MODEL ect.,I� L2 V uS )LAM FUEL
FLUE SIZE RETURN OPENINGS INPUT `40,00D OUTPUT 5Ce,OV7)
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.
EXIechanical ❑ 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 $ LP S.
STATE SURCHARGE $ .0
TOTAL PERMIT FEE $
i
This Application Becomes Your Building Permit When Approved Paid j 3 Receipt No By f 7 34
Date j,2_//943 7.r..C.
Building Official Date
24 hour notice for all inspections (952) 447 - 9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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