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CITY OF PRIOR LAKE
HEA TIN~I A TD rflNnTTTONTXTr' rjj'iD~PLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/03
Date Rec'd
IC)~" qJ"
Pink
Green
Yellow
~l~icant I PERMITNO'03_/J~ 0 I
0>y~s,,^,\:)o~ l, rl,lIt ~~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT 1 BLOCK ADDITION :3 (ti--
PID &), "0. OOt U
OWNER
(Name)
~''\4
35;a\.
(Phone)
~~~-~4-1~~~ \ d
\\)~)~,
\)<\i.S wt>O~ ~ y-~
APPLICANT f\,..... ~___
(Name) ~. ,).. ~~ \~;,... -LY\ l,
(Address) \ ~~ ~ C) ~~...\ \..0 th"-. ~\J "
(Address)
(Contact Person) N ~ ~
.-APPLICANT SIGNATUR --
(Address)
(Phone) '\ ~ d- ~ \.\l\ I' 8 ) ~ y
Q y 1 GV"'~Ll~~ 1\~ 5 5 -S, ~
(City) (Zip Code)
(Phone) '\ S ~ ~ "" ~ ., - ).? \ ~ VI
DATE \ ~ - ~ - ~
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL (. ~.. t"'"', "', '\,..0
FLUE SIZE "V c... RETURN OPENINGS
TYPE OF SYSTEM
PLACEMENT 0 AL TERA TlON~. -+--
S ~ - M V f - ~() _ \ ~ FUEL ~ r~
INPUT OUTPUT
HEATING OR POWER PLANT
OWarm Air Plants
OGravity
ttMechanical
Air Conditioning
ent. System
NlW
~~",,~l ,
~"G
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 12-05
PLEASE NOTE:
ir Conditioner Units
annot Encroach into
equired Side Yard
etbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
Residential, Additions & Alterations
Residential, AC Only
Building Pennit # OJ- /J " ()
~q'S~
'.50
\JO~'
,
$39.50
$39.50
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
lice Use Only)
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
ecomes Your Building Permit When Approved
Date
Paid -ftJ. vU
Dito . <j, ()
73
lo~~, 07
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
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