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THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/16/2008
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~
CITY OF PRIOR LAKE
~/AIR CONDITIONINGIFIREPLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 10-06
Date Rec'd
, ~l~icont \ PERMIT NO.t?5"""/O 18 I
ZONING (office use)
ADDRESS
1 ~ ,~S- ~ t\
Av e S.W
LEGAL DESCRIPTION (office use only)
LOT
BLOCK I ADDITION
PID
OWNER
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(Address) ,\, I () ~ e
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APPLICANT L \ --
(Name) r<\ ,__ y'-..~ "" ,...... \-V\ L
(Address) \ \D '~''D v.J ~ \ L u~ ~\{\.
(Address)
(Contact Person) N ~ "'\
.. <\PPLICANT SIGNATURE
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(City) (Zip Code)
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DATE \, ~ ~ ~ S-
ASE COMPLETE BELOW
REPLACEMENT 0 AL TERA TIONS
Y'-\., V ~ - \, ~ - d. (, FUEL JJ C1...T
INPUT \ O~ I (i ~ OUTPUT"), ~~ a
APPLICANT PL
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL t c........ ~ I "'" "5 ~
FLUE SIZE {)" L RETURN OPENINGS
TYPE OF SYSTEM
DWann Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64,50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
$39,50
$39,50
Estimated Cost $
Building Permit #
$ ~ I s"
$ .50
$ '-\~ QI;:)
-
HEArING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
fiee llse Only)
Date
Paid
qt?--
Date
/ ().- (;) '7-
This Application Becomes Your Building Permit When Approved
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372