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oc, VRlo� CITY OF PRIOR LAKE Date Rec'd
x HEATING/AIR CONDITIONING/FIREPLACE PERMIT 40-/.3.
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1.Pink File
`-INNEsolP 2.Green city PERMIT NO. /'tJJ /2
3.Yellow Applicant // 0
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
%'i ?CC Aelia had ,t/6- A'1 Sb
LEGAL DESCRIPTION (office use only) `'
LOT BLOCK / ADDITION vd�is 49,244. 1 A PID .25-44-0207--c•
OWNER ��//
(Name) �l "rieffi (Phone) X Z4 7.y ZY 7
(Address) /412 00 4 ,ee / /r
APPLICANT
(Name) Ron's Mechanical. Inc. (Phone) 952-445-8585
(Address) 2026 Colburn Drive Shakopee, MN 55379
(Contact Person) Linda (Phone)
APPLICANT SIGNATURE DATE /0- (S
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL LZ1�.%ll,4 )7OXVt%JEL N 7
FLUE SIZE RETURN OPENINGS INPUT O,OCD OUTPUT ,2)
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
Mechanical 0 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 $ 44.0
STATE SURCHARGE $ tQ
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid o IP Receipt No. sr
1
Date
Building Official Date 0 S By Ale�_
24 hour notice for all inspections(952)447-9850 /
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372