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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~: =w J;ucam I PERMIT NO. O~7.. 01 {31
ZONING (office use)
w\\D\~ 9(~ ~Lu
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2- S-. 3,?3 e ,> 0
OWNER
. (Name)
~~+~
'f'nJ f'I'
P~one) 052.- 2...l'l-'6ld40
.\Jdre~s l
\ '5'Lbl
W \ \ d.. ~ p\lM)~ lV,-G
A?P!..ICANT ..
(Name: B~~.e1
!\'( &t(\.J\ ('0 .l'f'{:. ,
~~\NJ ' \\:tOtkf'€) orLt '?"~;1e . lo~ - J..-1- Q>.- ,ll{O
~s ~C\ ~'A~ 1\..>.1- <SWCuJ\
. .I..... Llare~s ;
! C.Jntac: ?'::-scn! \' ~f\l~ ~\JJ.l()'~
,-"20r..~C:'i\iT );c~r"~~'~'?:: ~. t~l.illD.V'dL
'. "ddress) .
\Y\V\
55102..
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P~onel 6b\- ~L..-'3'-lt4.0
'J A~E 1 \t ff>lO')-
AP?L1C:..N-:'P!..lL-\3E CC1VIP!..ETE RE:'O'rV
~r::w: "NST?,f..'C'TN 'l:.. 'Z':::PI.."~.CE:vIENT .\L ~E=Z.ynCNS
,"~lZNr,C: \/U~K'::: .-\l'-iD [;ltOGL..
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:~:;1: SIZE
'(E,:JR."IOPENINCS
INTHr
OUTPUT
~::?E C'F 3~S'T::~Yl
:'iK-\'::':::i'fCJR ?C'iVS:R ?~..->'l\f':'
~W<lnn ,",ir P!<lnts
OGravlty
o Mechanical
~ir Conditioning
OVent. System
C Steam
o Hot Water
o Radiation
\\{ ~.(" 2:..~ 0 Special Devices
o Other Devices
PLL-\SE c\lOTE: Air ..'::onditioner
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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50' Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
(Office Use Only)
r-
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
OLl.5'O
$
$
$
Buildin2 Official
Date
Paid 40. ([0
Date 6 I. <..1
's Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245