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o. PRIo4 CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Z.1 t77 730. (3
��, 1.Pink File PERMIT NO.
NNEso 2.Green City /5 ////9
3.Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
ll-b. 6 grid 1,2 I� e TTrai II 446'
LEGAL LEGAL DESCRIPTION(office use only) _
LOBLOCK ( ADDITION 01--44,47C l Tc ih 21114/4,00,o/-2_5^,20-o22 -0
OWNER � a�-,�Yw\3 (D.�J` l"€V (Phone) Ora-130:4-433)-)
(Address) \k 1dV .1 c e 1 VLt.l
APPLICANT
(Name) Ron's Mechanical, Inc. (Phone) 952-445-8585
(Address) 2026 Colburn Drive Shakopee, MN 55379
(Contact Person) r,;nd (Phone)
APPLICANT SIGNATURE DATE Q ? -I'S-
-APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION LPKP;PLA ENT ❑ALTERATIONS
FURNACE MAKE AND MODEL IQ ln�,) s�. �,+i O O UEL ALTERATIONS,.
FLUE SIZE RETURN OPENINGS INPUT I OUTPUT l7O
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 0 Radiation Fireplaces with Box Additions or
❑Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
El 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 $ ' 4 •90
STATE SURCHARGE $ ..0;A.
TOTAL PERMIT FEE $ 1.01
This Application Becomes Your Building Permit When Approved Paid5 0, P Receipt No.
5e2 /4,
Building Official Date Date Q , Cc By
5 . 5......1
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372