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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~;e:n ~~~y \ PERMIT NO. 0(1 0 _. .J
3. Yellow Appltcant . (L. ~
ZONING (office use)
ADDRESS
'-It)~- fa
/VA fA L.i ~
72J Jt) ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
---;-0 rn '6),..-/ tl u. )
.s'~ Tn e.- ~
(Phone) O;f:d-- y'f-O .;;;/07'
J
(Address)
(Address)
BURNSVILLE HEATING & Ale. INC
3451 W. Bu\ 115ville Parkway
Suite 120
(AcBumtiv1lle, tvIN 55337
(Phone) C0 ('J ~j<l OC)C)~-
APPLICANT
(N ame)
(City)
(Zip Code)
(Contact Person)
~i~
/lIIiAC
(Phone)
DATE S- -6 -()€J
-,
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION EPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL ~ 0 Y I<- P ,.-q 8 I;:). III iJ 6tJ u t 1/ FUEL A/ ib~!;
FLUE SIZE RET RN OPENINGS INPUT & C) (JOC) OUTPUT .~,~ OCO
HEATING OR POWER PLANT
TYPE OF SYSTEM ~~,:.-VL>
OWa~ Air Plants ~~~
OGravlty -;- "
~echanical
[JV..ir Conditioning ~. TO n
OVent System
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 & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99,50 Residential, Additions & Alterations
$64,50 Residential, AC Only
$J'ue '
Industrial, Commercial & Multi-Family
~~~U
~
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
Ljq
.50 O~
~.~.5': O~~ ..15
paid50.OV
Dat~
05575/
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Buildinl!. Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372