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I'
CITY OF PJ THIS FILE HAS BEEN
HEATING/AIR CONDITIO CLOSED DUE TO
INACTIVITY 4/16/2008
REQUEST FOR FINAL
INSPECTION SENT TO
at bottom) HOMEOWNER 10-06
~ e Av& I\J
Date Rec'd
Pink
Green
Yellow
~l~icant I PERMIT NO.0'5"'lJb~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
O~ER 1
(Name) 5 hevj_
(Address) I 4-31
(Phone) q5~ - '-fq {,- ~& 1:1
APPLICANT
(Name)
BURNSVILLE HEATING & AlC, INC.
3451 W. Burnsville Parkway
SlIlte 120
(AddreBUrnsville, MN 55337
(Phone)
(Address)
(Contact Person) -Be+1'1
~ Nle" ~on
(City) (Zip Code)
(Phone) qSJ. - ~qLf- 0005
DATE 1 a-f.,T fJS
I '
. PPLICANT SIGNATURE
DNEW CONSTRUCTION 2J'REPLACEMENT o AL TERA TlONS
FURNACE MAKE AND MODEL Lc, n Yl 0 '/.... 6 (PO U ~v b(,(.t- D1D FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants o Steam PLEASE NOTE:
DGravity o Hot Water Air Conditioner Units
o Mechanical o Radiation Cannot Encroach into
OAir Conditioning o Special Devices Required Side Yard
OVent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & NC (N~:w Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ --.!:f.31fD. i5D
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
,3q..50
.50
40, 00
lice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
pait( () __
Dat~... 5.... )"
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372