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8
I
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2. Green
3. Yellow
(,.2.2-, OJ
I PERMIT NO. 0Y',,04-031
File
City
Applicant
I ~iIs;_::"bottoml
~d\~ ~1kr-nld C ..01cOo.
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~=Rj\m~~
(Address) 3d \ <::6 .
(Phone) ~~d- d \'ri- - ~ d.&~
APPLIC~T ' \ ~ I L. . .1
(Name) ~Q AJY)V\. \ H:.. tiC Cn \'8 ..... ~
(Address)~\ W' 6'v\H-e ~\..l0.L. ~ DO
(Address) ---cr
(Contact Person)
(phone) C1S 2-~ctl.{ r an5
--hJ A f\Ij \A' k SS3-rJ
(City) (Zip Code)
(Phone) ~.,..
DATE (O-I )-09
DNEW CONSTRUCTION !1J..REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODE~ ~Oll~~ FUEL ~ ExLO
FLUE SIZE RETURN OPENINGS INPUT C{()ltXJ OUTPUT J(p ,tIi)
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants o Steam Units and Fireplaces Cannot Encroach
o Gravity o Hot Water into Required Side Yard Setbacks.
R1 Mechanical o Radiation
~ir Conditioning o Special Devices Fireplaces with Box Additions or
DVent. System o Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL -
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % 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
$ WO\ ,:SO
$ .50
$ ~ ')..t"n
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Duildin!! Official
Date
Paid .5V. (JT)
Date&,. Z.Z,O
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372