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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~;~:n ~~:~y I PERMIT NO. oe {)4-ISI
3. Yellow Applicant ,
ZONING (office use)
\ \\ \ ::2()
~,~~~ \\\I~ N ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~=R .() 0-\ ~ )<"'c:... \\ \ \G.. ~ \}
/
(Address) \ ~ \ ~O Sf " .So ~ '- ~ l
(Phone) \o\~-??\ ~() ~ l\ \
APPLICANT h \1\... I ~
(Name) \'<\.J-..\ ~ "")...... ~n "-
(Address) \ ~ ~ ~ (J \J ~\ l{)~ (\ \fZ(J Y'"\ ~ ,.-.
(Address)
(ContactPmon) ~<.~ ~
APPLICANT SIGNATURE .
(Phone) ~S ~-""~l-'~\ ~~
\.. ~"\, ~ " ~ S ~ 3 ..., ~,
(City) (Zip Code)
(Phone) ~ ~ ~ - '" '"VI (" &, }.~
DATE ~_.~~_.~
APPLICANT PL E COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL ~ ''y ~'"' \: ') \ ~l\\\ V ~~~ ~ I\. ~ FUEL N rv.-t
FLUE SIZE RETURN OPENINGS INPUT c", ~ ~ OUTPUT\ \ ~6
,
DWarm Air Plants
DGravity
,[1 Mechanical
~Air Conditioning
DVent. System
:)Y ~ \- <J,
HEATING OR POWER PLANT
D Steam
D Hot Water
D Radiation
D Special Devices
D 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.
TYPE OF SYSTEM
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
Residential, Heating & AlC (New Construction) $149.50
Residential, Heating Only (New Construction) $64.50
Estimated Cost $'slu % <s;.,....
$49.50
Industrial, Commercial & Multi-Family
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Building Pennit #
$ ~ ~ rlJ
$
$ -5~ ~
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
.50
(Office Use Only)
Buildin!!: Official
Date
Paid 50 v OU
Dat1t . J, '1 . 0
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372