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CITY OF PRIOR LAKE
HE A rr'T1U'-' I' ~~ - - - /FIREPLACE PERMIT
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/16/2008
Date Rec'd
~. :.:n ~::y I PERMIT NO. 0' ;;) - 7 7,-c;J
3, Y.\low Apphcant , J::::J
atl
ZONING (office use)
;/159 3Jbt!dl
y
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
, ADDITION
~~
PID
OWNER
(Name)
(Phone) '157, '-d)~ - 9tJ7d--
(Address)
(Contact Person)
(Phone) 743'" 757 -b;7;)t:{)
~
(City) (Zip Code~ J
(Phone) /f? '3 ;7 5/ ./~ cf/J.<?~"S(/;
DATE s=.?P il?
APPLICANT
(Name)
(Address)
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION ~ REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL ' FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
OWarm 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
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1 % 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
i;,Sh:/l/d r/:f/
I ) j ,1/'1/f)/(
Estimated Cost $ C'1 '7'd J
Building Permit #
HEATING PERMIT FEE
ST ATE SURCHARGE
TOT AL PERMIT FEE
~--:~I r~
.-/ / -
$
$
$
,50
L,l.....\.. \.~__~
Date
"ffiee Use Only)
,'his Application Becomes Your Building Permit When Approved
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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