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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~i~~:w JJ~icant I PERMIT NO. 013,000.51
ZONING (office use)
iL\ \ I
Shole-- Ln ~G
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNE~
(Name)L:\~t1L1~~
(Address) \L..\ \-,
In Q -t--\t i aLL) ~"t-7.-..J
Ln r-J L
(f~ - 4'--\ ~- I (.01 0
(Phone)
(Address)
(Phone) q ,~~\- IOqq
IdL/
(Contact Person)
'"'----..
DATE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION PLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL lI-LLuci - lJE:rt:Gd_CJ 1 FUEL ~--tf-urCL(
FLUE SIZE 5 II RETURN OPENINGS INPUT /5) CJ.n OUTPUT(o[:), cr::x.:::;
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants 0 Steam
o Gravity 0 Hot Water
a Mechanical 0 Radiation
Ja1\ir Conditioning 0 Special Devices
DVent. System 0 Other Devices
OiC-
.:}1I~. Ln~E MAKE AND MODEL hLLLd - ClON L (~6,L}-
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.
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39,50 minimum
$99.50 ~sidential, 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 $ 5~
.J
Building Permit #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~.SD
.50
L\()cD
Buildinl! Official
Date
4-0,00
l. 7. ~6
Paid
ipt No, S5{z...O
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
1 6200 Eagle Creek Avenue, Prior Lake, MN 55372