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CITY OF PRIOR LAKE
IlEA rING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
; ~';I:~~n ~i:~y I PE1{MIT NO. 0 a. .0
I. Yellow Arr1kllnl _ 0
l
153761 ~f ~ IV-.
LEGAL DESCRIPTION (office use only)
ZONING (office lI~e)
LOT
BLOCK
ADDITION
PID
]
OWNER '\
(Name) iJ~ /""\(;~~
_ -----. '---. (Phone.) 9>5:;. - ;Z ~ - ;).,;A 7 :;-------J
~ ;;;;i~ I /1,,0 XJ 7).. ____
~~dress) /53767 ;j~ 7~~_
AIR MASTERS1Nc
.:I::r.j"'~ [",~.''':.II'J~I.J.'('l~II~[CIJ
6915 -146th Street West
Apple Valley, MN 55124
(952l 431-5932
(Contact Person) ~ __ \' done) __H______.
APPLICANT SIGNATURE ~y /~ ____ DATE ---ilfj)-'i?'/L;r
APPlJICANT PLEASE COMPLETE UELOW
I DNEW CONSTRUCTION rkJ'REPLACEMENT 0 ALTER'A;fIONS
FURNACEMAKBANDMODBL _~ - Sli'I1Vt3 tJ6CJ _ FUEL ~ A<?-~
FLUE SIZE ;;.. &' RETURN OPENINGS INPUT 6:7" tJ 0 0 OUTPUT ....1?{ 0 b-o_
APPLICANT
(Name)
me)
(Address)
(City)
_.
(Zip Code)
TYPE OF SYSTEM
OWmm Air Plants
DGravHy
IN Mechanicnl
DAir Cnnditionillg
DVent. System
HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
info Required Side Yllrd Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of lJuildings
Require a IJuilding Permit.
o Slenrn
o 1-101 WaleI'
o Radi:llioll
o Special Devices
o Ol.her Devices
----------...----..
1 FIREPLACE MAKE A~~ MODEL
Industrial, Commercial & MlIlli--Flmlily
FEE SCHEDULE
] % of job cost Re.~iclential. Ga.~ Firep]ace
$49.50 minimum
$]49_50
$64.:'iO
$49.50
Residential, Healing & Ale (New Construction)
Residential, Heating Only (New Construction)
Rcsidetllial. Additions & Alterations
Residcnthl. AC Only
$49.50
$49.50
Esilirnated Cost .$
~tJotJ ,.
",0
-
(Office U~e Only)
This Application Becomes Your Building Permit Whet. Approved
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
-IJ
$_'f1:. ~
$-> 1)0 .50
$_ 5.-<>..
UHte
Paid C>-\
ov . UO
Dal(l. ~r.
I NO'5713
Buildine Officinl
24 honr noliee for 1111 inspections (952) 447-9850. fax (952) 447-4245
4646 Dakof.1l Street S.E.. Prior J.nllP_ MI...."<nln C:~ ,.,.,