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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2. Green
3. Yellow
~~!tey I PERMIT NO. 0 Cl" 0 7. .... ....L
Applicant . I. '- ~
ZONING (office use)
\ ~ lo \ '1.. W~L(()cd )JL
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
(Address)
0f)S
(Contact Person)
APPLICANT PLE SE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
FUEL
OUTPUT
HEATING OR POWER PLANT
DWann Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$49.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$49.50
(~49,.50 -,
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ '-tel. SO
$ .50
r----1~ 0 n
$ v)L' )l.
(Office Use Only)
Buildinl! Official
Date
paids~ VO
Date _ I
S" ~v
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