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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
5'1 I rj87
~.~i~:n ~:~y I PERMIT NO. 67 -()~'~I
3. Yellow Applicant . ,
ZONING (office use)
W o1-ee s I~ye-
-n.Q
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name) ~
(Address)
.\<v..b+
(Phone)
APPLICANT'
(Name) \Jf U f $'l S
(Address) \
(Contact Person) ~
(to Oc. '~-HU ~
#ClV\ L
(Phone) 'l:)... - 'X,C:,~'- ( ~ 7
~ L- ~?l
(Address)
(City)
(Zip Code)
APPLICANT SIGNATURE
(Phone) ~t J- ?~Co IS 3 '7
DATE 5' -/7-tJ7
DNEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS
rURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants o Steam Units and Fireplaces Cannot Encroach
DGravity o Hot Water into Required Side Yard Setbacks.
o Mechanical o Radiation
~ir Conditioning o Special Devices Fireplaces with Box Additions or
Dent System o Other Devices 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 & AlC (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 5' . S-O
.50
'fO.OO
(Office Use Only)
"'his Application Becomes Your Building Permit When Approved
~om'~ !>frjo7
Receipt No. 5'3 ~() (,
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372