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CITY OF PRIOR LAKE
HEI ~~- - - . . - FIREPLACE PERMIT
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/16/2008
Date Rec'd
(/.36. OS-
L Pink
2. Green
3. Yellow
~:~y I PERMIT NO. 05 0 I" Z ~
Apphcant 4 (&:1
at bOLwm
ZONING (office use)
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LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
PID l~. -z,C( q . () Z t; .0
OWNER
(Name) Dtb
(Address) 6g
(Phone) q5~ - 4-4-1-1055
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APPLICANT
(Name)
(Address)
(Contact Person)
BURNSVILLE HEAliNG & AlC, INC.
3451 W. Bumsville Parkway
Suite 120
B~9001~) MN 55337
(Phone)
(City) (Zip Code)
(Phone) q 5~ - g q'-f - 0 DDS
DATE
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION PLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
OWarm Air Plants
o Gravity
CJ>kchanical
.-e:1Air Conditioning
OVent. System
INPUT
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
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
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ 3 q . ,J) D
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 8q .GD
$=:t=g- .50
Do()
$ ,
~e Use Only)
This Application Becomes Your Building Permit When Approved
Receipt No. "~720
By
paid.fO. {; U
Date &. 3'(1.05'
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372