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O � pRlp� CITY OF PRIOR LAKE Date Rec'd
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�INNES��A �. P�� File PERMIT NO.
2. �� ��ty �Z -o �8
3. Yellow Applicant
lease e or ' t and s' at bottom
ADDRESS ZONING (o8'ice use)
2��-7 �(ds [�� � � ��c�r L���
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N� � � � l� � 1 � � (Phone) ' JL � �� �
(Address) �� � � � t � �lJ'lf � Li I ' l 1 L � l �
APPLICANT
(Name) Rons Mechanical Inc (Phone) 952-445-8585
(Address) 12010 Old Brick Yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) L i nda (Phone) 9 5 2- 4 4 5- 8 5 8 5
APPLICANT SIGNATURE V`il�V`�' ' DATE b' I ��
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION [�REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
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.
[�lyiechanical ❑ Radiation
[v�Air Conditioning ❑ Special Devices Fireplaces with Boz Additions or
�Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
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
Estimated Cost $ l �� Building Pernut #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $
until june 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00 —
This Application Becomes Your Building Permit When Approved Paid �- �/� Receipt No. � O�
`7 6
Buildine Ofticial Date Date � f t � L By �
� J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372