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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
()
f\, t\ J~" u,> \- f\- V L
~. ~i~~;w J~~icant I PERMIT NO. 0 e . Q 98 ~
I
ZONING (office use)
~~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER..- \). 1-
(Name) ) ~ " (\ (\ ~ \..) rl.i c., \ "l.a
(Address) ,5 ~3 () ~ \ ~ ., ~ n-V",\.
APPLICANT N\ \- I^
(Name) \ . , ,-,..--\) n \ r- --..1 n L
.
(Address) \ \u '\ ~ \~ ~ ~ 0 w~ f\ V\.
(Address)
(Contactpcrson)~' '"\ '"'J ~ ct^
APPLICANT SIGNATURE / '-..; ~
(Phone) CJ r ~..,,-\~l) .lo\~S-
(Phone) 9 S) -l\~\I- <R \~"
~ r-, ~(J ~ '-s\~ t\~ ~ '3, ~
(City) (Zip Code)
(Phone) C) \ ~ ~ '-\~, ~\')., '\
DATE \\-~ 5 -~
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL ~,",J u,,-\
FLUE SIZE \)"\ c "3\1 RETURN ~PENINGS
REPLACEMENT D ALTERATIONS L
") "-' a (\ 't\ \; C) '" ~ - CJ X'LJ FUEL f\J '" "
INPUT <t \j . ~ l) OUTPUT'1-'s I .~
,
TYPE OF SYSTEM
~Warm Air Plants
OGravity
o Mechanical
DAir Conditioning
DVent. 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
Estimated Cost $
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50
$64.50
:;) d Q() ~
$49.50
Industrial, Commercial & MuHi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~ ~ ~0
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
SQ~
Buildin!! Official
Date
Paid 5tJ. CIt.J
Date I Z. L... c)~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372