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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink
2. Grecn
3. Yellow
File
City
Applicant
S-/ot/o "7
I PERMIT NO. 07 - 0 ~lt..f
I
ZONING (office use)
ADDRESS
5/'3~
J"'s\ CrV\~ ~ l~W
QD
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z.. ,;- . 2- 52-. 0 I J' . ()
~=R DCA \) I V) ----=r{,~so.,J
(Phone)
(Address)
APPLICANT , '\.
(Name) ~~ f'..)~ S\ 5
(Address) j ~O d \.
~A:-" l,u b
MCI~.~ ~
GD.-D
(Phone)
I\JL
S~~ ~1 ~
"
(Contact Person) ~
(City) (Zip Code)
(Phone) 9. )). - l..{\{ 1-- 37";;"'"
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION EPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL ~UAAWZ..~ ,- FUEL A,j'/rf
FLUE SIZE RETURN OPENINGS INPUT 1M ~O OUTPUT q~ttf6)
TYPE OF SYSTEM
HEATING OR POWER PLANT
DWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3'i. f;O
.50
4/), () lJ
'')ffice Use Only)
Date
Receipt No. 53 If Y I
By
,'his Application Becomes Your Building Permit When Approved
~ ~ 5"!<t!07
Buildin!! Official Date
Paid
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372