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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
i ~~~:w l;~icant I PERMIT NO'OB. 054=2.1
ZONING (office use)
ADDRESS
30q~ ra;(Vievv Rd
Fi lor li1 f("P
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~'::~~( II ct (at 0 I V~1nqG rill
(AddreSs)3CJQh f(Urview R'd filar LaKe
~;;~~m-r,-' tl1ech .4nl cO{ f In{j
(Address) 1'2~OIC) Oil Brif~~' Ufa
(Contact Person) (jnd tf
nRJ_ UU-7.1J 1....::.7 I
(Phonerl JL- -I' L{J
(Phone) Cfm- Lfit5--8S85
5h IJ L ~ SS37Q
(City)
(Zip Code)
(Address)
APPLICANT SIGNATURE
DATE
1..ll9: D'b
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
DWarm Air Plants
DGravity
j;eChanical
ir Conditioning
Vent. System
HEATING OR POWER PLANT
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
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50
$64.50
$49.50
Industrial, Commercial & Multi-Family
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Estimated Cost $
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$~
~ f1).OO'SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildinl! Official
Date
. I,) (.,
Paid ?7J .--
Date
eipt N~~) 1
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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