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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
9. s. ()~
~. :;:'n ~:~y I PERMIT NO. 0 I 0 (J,.,/'.A I.
3. Yellow Applicant , " . C/ ~
ZONING (office use)
r--.lL
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER ~ i ~ -.A ~u~
(N ame) ..I 0...,.
(Address) 14 7~2> ~r-;~ t\,d.~e..... Tn.. ~E-
q5;,:). -, II r .
(Phone) ...,7 - 3LJ.qL)
APPLICA~
(Name) le_r~ ~-t-\"'\~~<.\ .>--t--ttJ.
(Address) L"qSo l~. \4~ -fu6t-. -::it=: ~
(Address) 'I
(Contact persor6'LLLL.n....
APPLICANT SIGNA TUR
(Phone) ~ -i-\-~\ - '>J CAe,
CLpp\~ un., l~ S5Uy-
(City) 0 (Zip Code)
(Phone) QS:L-4~(- '70QC)
~
DATE
APPLICANT PLEASE COMPLETE BELOW
-he- DNEW CONSTRUCTION PLACEMENT D AL TERA TIONS
""UKNALt MAKE AND MODEL ~en ~ I-i t..j A 3ol,. - ~~ FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
REA TING OR POWER PLANT
OWarm Air Plants
OGravlty
o Mechanical
-f2I'mr-Conditioning
OVent. System
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
FIREPLACE MAKE AND MODEL
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 $ .;l~
,
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
..3Q. 60
LID ~8
'fIiee lIse Only)
Building Official
Date
4--0.00
9. S;Qt
Receipt No. S Zz,e 0
fhis Application Becomes Your Building Permit When Approved
Paid
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372