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CITY OF PRIOR LAKE
REA TING/AIR CONDITIONINGIFIREPLACE PERMIT
~--~-;
E Me, SoU:tt1 ElAS,-t
Date Rec'd
4. I/. oE;
~ ~i:. f~kant I PERMIT NO. 08, 0 I ~91
I
II WNlNG(_~)]
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDmON
PID1..5. t 3 O. 001. 0
OWNER
(Name)
(Address)
APPLICANT SIGNATURE
(phone) 95.2- 226 -sO/d'
,SE
r r
(phone) {j So I ~ /.Q3~- )042
tZo~I!lIU . .tuJ
(City), (Zip Code)
(phone) CJ~2- &'~O ~07 .r..~
DATE 'f/to/~
APPLICANT P
ONEW CONSTRUCTION
FURNACE MAKE AND MODEL
FLUE SIZE RETURN OPENINGS INPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
E COMPLETE BELOW
REPLACEMENT 0 ALTERATIONS
FUEL
OUTPUT
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 'Residential, AC Only
DWann Air Plants
~ravlty
Mechanical
Air Conditioning
oVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Consbuction)
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Vie Only)
This Application Becomes Your Buildinl Permit When Approved
BuUcUDII: omcial
Date
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of BuUdlngs
Require a Building Permit.
$39.50
$39.50
$39.50
Building Pennit #
$ l{.q .SD
$ .50
$ S7J , ,-i)
Paid 50,(5U
Dat~ . ( I, of:.J
0'55573
24 hOUI" notice for alllnspecdODI (952) ....7-985., fax (952) 447-4245
4646 Dakota Street S.E.. Prior Lake, Minnesota 55372