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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1(., i C{(
1. Pink
2. Green
3. Yellow
File
City
Applicant
I PERMIT NO. od'.. 09z.-z]
,
I
ZONING (office use)
ADDRESS
/rVL
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
APPLICANT
(Name) fUvt'N(;~<:1 P1"....br...S sJ.,),z,-s ILL
(Address) /571/1/ Ov'>Wt1 sr (lJE
(Address)
(Contact Person) s;',,^.1 J...-v>~
APPLICANT SIGNA TCRE
(Phone)
l4y'/;o L</<
(City)
(Phone) -n s-2fl.' z~n
DATE /1 '../ ry-
553&11
(Zip Code)
DNEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
OWarm Air Plants o Steam Units and Fireplaces Cannot Encroach
o Gravity o Hot Water into Required Side Yard Setbacks.
o Mechanical o Radiation
OAir Conditioning o Special Devices Fireplaces with Box Additions or
DVent. System o Other Devices Cantilevers to the Outside of Buildings
4~ V'/VII fIrn--. Require a Building Permit.
-fIREPU,CIZ M.\K.f: AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50
$64.50
$49.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 41- 5V
$ .50
$ .1:FV. () ()
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildin!! Official
Date
Paid 5"0 " vt)
Dat~
I( .
'pt No. .570 19 6
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372