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THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/16/2008
CITY OF PRIOR LAKE
, A TD rONDITIONING/FIREPLACE PERMIT
,--- _ ~QUEST FOR FINAL
'~NES~ INSPECTION SENT TO
(Please type or print and sign at bottom, H 0 MEO WNER 1 0-06
I ADDRESS
. / &45'1 5L!4/,f tI~l7a. '2u,J;
(/
LEGAL DESCRIPTION (office use only)
Date Rec'd
~.:~n ~:~. I PERMITNO.~ 100.0
3. Yellow Applicant . ' 0
ZONING (office use)
(i
LOT
BLOCK
ADDITION
PIDzS. oQS. 0-4-3. 0
OWNER
(Name)
e,7/ I-f!
/~'r
(Phone)Q5dv '1~O- it; $ b
(Address)
APPLICANT . /7 '
(~:::S) ;;~;~1;~PAd ;Vb
(Address)
~;;~! 3 '~~~~~2
(City) (Zip Code)
(Phone) (// ~. ].) / -~~)
DATE
(Contact Person)
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS /I't1J4/t \
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
OWann Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. 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
EDutfC
Residential, Gas Fireplace
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost $ cl.) u t/U
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.3 q 5u
.50
,-/(J, 0()
lice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
paid4v_
Date ZZ dS
/0, _
Receipt No. 5034'2-
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372