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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2. Green
3. Yellow
File
City
Applicant
\ PERMIT NO. 08. 0 I?; ~
I
ZONING (office use)
ADDRESS
s; /J~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
(Address)
::D4-U; (.1 0 Ace) 6
S>t r,l'Je
(Phone) q~"';). ;J. </0 9/7 i
OWNER
(Name)
(Contact Person)
BURNSVlLLE HEATING & Ale, INC
3451 W. Burnsville Parkway
Suite 120
<C-. ...... ..8tMTS\l\lle. MN 55337
~~.:.J P/ S4:. .Y""I '
(Phone) ~} i~..L fC:}<f OOC/ r
APPLICANT
(Name)
APPLICANT SIGNATURE
(Phone)
DATE
(Address)
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION EPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND\10DEL FUEL
FLUE SIZE
TYPE OF SYSTEM
OWarm Air Plants
o Gravity
o Mechanical
~ir Conditioning
OVent. System
RETURN OPENINGS
INPUT
OUTPUT
.a ,. {..~
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Residential, Heating & AlC I,New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50
$64.50
$49.50
Industrial, Commercial & Multi-Family
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STA TE SURCHARGE
TOT AL PERMIT FEE
$
$
$
~ Cj -S7J
.50
67:) .a)
(Office Use Only)
Date
Paid 60. 00
Date +'. -z, 2-, () 1:.
o. &5'654 0
This Application Becomes Your Building Permit When Approved
Buildinl! Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372