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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
D!ltll R.lll"d
/0./7-07
~'~;~:n ~:~y I PERMIT NO. 07- 100 ~
3. Yellow Applicant ~
ZONING (office use)
6/ ucfl '
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
(Phone) ~/~S-- tJ c;t 3..:3
l3/vtP /n .J
APPLIC~ '. J / ' fi' /J 0:1 -
(Name) y..-aa/' Iy /7' "'A-h/J/ ; I If e f'v" ct> So LtJe, _
(Address) J;2 9/.2 /I &n -h I'A.. L-4Jtt I' 'I- ~ .':I~ ;Z /
5f>jdress)
(Contact Person) ~ ~ ~D c-
(Phone) t. t}SJ.) .L/o 3 - /110
Sh~~fe~' JnAJ 5S37'7
(City) ..I (Zip Code)
APPLICANT SIGNATURE
(Phone)
DATE
/o~ / 7-07
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION EPLACEMENT D AL TERA TIONS
FURNACEMAKEANDMODEL Jt>urnham {df)',/pf hJf)Jel dosfC FUEL L P
FLUE SIZE t i/ RETURN OPENINGS ~'1r 1/ INPUT 1.3~D{JO OUTPUT /O!!otX)
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
DGravity
D Mechanical
DAir Conditioning
DVent. System
D Steam
~t Water
D Radiation
D 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
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 $ 4/400. tJ"i)
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~9.SD
.50
.if O. lJ'l)
(Office Use Only)
Buildin!! Official
Date
Paid 4-tJ _ {/ 0
Date/O. 17. (;;
Rec ip No. ,5~+O
B
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372