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CITY OF PRIOR LAKE G ,HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Ric ..
4/INNEso'�P 1.Pink File PERMIT NO.
2.Green City iL
(Please type or print and sign at bottom) 3.Yellow Applicant /jI I
ADDRESS 1
4 452 Co t ov ado S--re t. s' ZONING(office use)
LEGAL D CRIPTION ffi use only)
LOT BLOCK ADDI ON PID 25:102.
OWNER
(Name) M 1 Chef Ie 13rq,Y +-I'
(Phone) 6251'2.10-39a9
(Address) 4 452 Colorado e rte 8e
APPLICANT
(Name) Ron's Mechanical, Inc. (Phone) 952-445-8585
(Address) 2026 Colburn Drive
Shakopee, MN 55379
(Contact Person) Linda
(Phone)
APPLICANT SIGNATURE ► i I i inCk
DATE
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION , L EPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL COI.V r 1 Qil( 55M1..ACR° FUEL IJ b
FLUE SIZE RETURN OPENINGS INPUT 10,CCO OUTPUTO
TYPE OF SYSTEM ��•�
HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
0 Warm Air Plants 0 Steam
❑ ravity ❑Hot Water Units and Fireplaces Cannot Encroach
I rJ Mechanical into Required Side Yard Setbacks.
❑Radiation Fire
❑Air Conditioning ❑Special Devices places with Box Additions or
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
Residential,Heating&A/C $49.50 minimum
(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 $ LIC(.5)
STATE SURCHARGE $
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid
1
/�/t J 6-0 g131
Receipt
Building Official Date Date t/', l/ J) � ,✓ By . 5,,..-----
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372