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THIS FILE HAS BEEN
CLOSED DUE TO
CITY OF PRIOR I INACTIVITY 4i16/2008 Date Rec'd
HEATING/AlP rOl\TnTTTONTNGIJ /2 05
REQUEST FUK J11NAL . ,
INSPECTION SENT TO
HOMEOWNER 10-06 11 I PERMIT NO. 05"./1..Ilf
E~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
APPLIC. .ANT IC' ' . 1\... ... Q
(Name)~1 ( ~
(Address)
(Contact Person)
APPLICANT SIGNATURE
DATE
APPLICA
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL
ZONING (office use)
PIDZS.04&. 008 0
PLEASE COMPLETE BELOW
o REPLACEMENT 0 AL TERA TIONS
FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
INPUT
REA TING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
DWann Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Residential, Heating & AIC (N(:w Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit # 6 =:;. /2 / L
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
39.50
l/f)50
4-0/
'\jce Use Only)
fhis Application Becomes Your Building Permit When Approved
Paid ~. (A)
Date
IZ--. 17.- . OS-
Date
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
$39.50
$39.50
$39.50
Receipt No. 51J 820
By