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CITY OF PRIOR LAKE .
\ .
THIS FILE HAS BEEN UNGIFIREPLACE PERMIT
CLOSED DUE TO
INACTIVITY 4/16/2008
Date Rec'd
I. Pink
2. Green
3. Vellow
fJ~icant I PERMIT NO. LJ3 - to (0 41
ZONING (office use)
'/5lJ
LEGAL DESCRIPTION (office use only)
LOT LOCK 1J:DDITION ~.d
j)
PID
-()
OWNER
(Name)
(Contact Person)
S?f eU e.
/5/
APPLICANT, \ A ~ --L I. ...L 1.../ c D.:-o , /.-
(Name)~e-slcl~ P{1rJ n r tlOf11e (Phone) tj/;?- 0 -/tJ,...tJ7~1-5
(Address) S?i> -Lv. HfplA /'1 8tttir.rt/,jlp,/h)t/. ~.33:7
(Address)V (C?ty) (Zip Code)
(Phone) %eJ- f'9t7.-cJ7~8
'a
(Address)
(Phone)
~~- '/17- S~.f
APPLICANT SIGNATURE
\
DATE
APPLICAN
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL
FLUE SIZE
RETURN OPENINGS
PLEASE COMPLETE BELOW
o REPLACEMENT 0 AL TERA TIONS
FUEL
OUTPUT
INPUT
TYPE OF SYSTEM
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. 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
~p 1:1
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 & AIC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Penn it #
'lice Use Only)
{his Application Becomes Your Building Permit When Approved
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245