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__~/21/02 fRI 08:36 FAX 6124474245
CITY OF PRIOR LAKE
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CITY OF PRIOR LAKE
HEA TT1\7~1 A TO ("'nl\TnTTTn1\l"1\l'{::<1li'T~PLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/05
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Date Rec'd
/2- _ z-. {J+-
~: ~ ~~ I PERMIT NO'04- I ZU (p ]
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ZONING (of/lce \1St)
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LEGAL DESCRIPTION (otl'lce u..~ only)
LOT II BLOCK I .ADDmON KflOP IIIL.{. 57?(
OWNER . .- j I r-. ,1/
(Name) ~O bQ..r t )cJi I r)o 'a-
(Address) \ 4-1- '1 (~ U OV e Court t-.J ,6 .
APPLIC~T) l~.. .
(Name)~Q..,
(Address) /'9 0 '1'0
Hit ; 4/ t-- Il\Jc.
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(Contact Person)
Pill z..>. 3((;8. 01'. 0
(phone) q f)Z - "[ 2)') - ~ 6
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(Phone) q 02 - qif;( - t/ Z I ,
Lei en Prair",'t HAl 553~1
(City) I (Zip Code)
(Phone) Q5Z -q ~{ - ~ 2 Jj
DATE I Z./I /04-
PLICANT PLEASE COMPLETE BELOW
[JNEW CONSTRUCTION 0 REPLACEMENT AL TERA TIONS
11~~~~~a ~
FLUE SIZE RETURN OPENrNGS INPUT OUTPUT
TYPE OF SYSTEM REA TING OR POWER PLANT
OWarr<1 Air PlllIlts 0 Steam
OGravity 0 Hot Water
o Mechanical . 0 Radiation
tJAir Conditioning 0 Special Devices
OVent. Sylltern 5a' Other Devic~s. qCJ"J ~QeJai (J 17
FIREPLACE MAKE AND MODEL un,'; 11' u- '1'0000
Industria!. Commercial &:. Multi-Family ~ 1% of job ~~~ S( REQUEST FOR FINAL
Residential. Heating &. Ale;: (New Constructi n) ~~:;g minimum INSPECTION SENT TO
Residential, Heating Only (New ConstMJctio ) $64.50 HOMEOWNER 10-06
\~~ I i^rY'\ 00
~ C!7 Estimated Cost S "7\..../ lA.I. -
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(omre Use Only)
PLEASE NOTE~
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39,'0
$39.50
$39.50
c,.,. c..
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OUlldltlg Pennit # (.'9 ./2 tJ fc
HEATING PERMIT FEE
ST A 1E SURCHARGE
TOTAL PERMIT FEE
This Application Become3 Your BUilding Permit When Approved
.Buildlpg Orndtl
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24 hour notice for alt inspections (952) 447-9850, rax (952) 447.4245
$
$
$
2;Q. 50
.50
4-0. 00
Paid Receipt No. 4t? Y L
40. uV
Date By //1..,-../7
/2.-;.04-