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A. 4 ' e HEATING/AIR CONDITIONING/FIREPLACE PERMIT /O. zCP (C
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"4 n ck$50.50 JOB288294 P0804029
i.Pink File PERMIT NO. /�
4I/A7siisOKA /2.Green City iR
3.Yellow Applicant �/ /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
16750 Anna Trl SE f 7
LEGAL DESCRIPTION(office use only)
LOT LOCK ADDITION — —4 A..) . Alckt v PID ZS- O/c?—,6100 - ?'
OWNER John Vanvalkenburg
(Name) (Phone) 952-221-7015
(Address) site
APPLICANT
(Name) Blue Ox Heating&Air (Phone) 612-238-9709
(Address)5720 International Pkwy,New Hope MN 55428
(Contact Person)Jennie Wood - Ai., 612-238-9709
APPLICANT SIGNATURE // / DATE 10/15/15
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION Q PLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL Goodman AMEC960803BN 80k BTU 96% FUEL gas
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HT ING OR POWER PLANT PLEASE NOTE:Air Conditioner
0 arm Air Plants I kteam Units and Fireplaces Cannot Encroach
ravity ' of Water into Required Side Yard Setbacks.
E Mechanical M. 'adiation Fireplaces with Box Additions or
rim' it Conditioning IN Special Devices Cantilevers to the Outside of Buildings
• ent. System DOther 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 $49.50
Cost$ 5700 Building Permit#
HEATING PERMIT FEE $49.50
STATE SURCHARGE $ \
TOTAL PERMIT FEE $50.50 //�
This Application Becomes Your Building Permit When Approved Paid �o .c--D Receipt No. Z jto
Date e r1�tt c By �-
Building Official Date l • 0 ,>
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372