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CITY OF PRIOR LAKE Me
16200 Eagle Creek Av. S.E. Perm~ No.
Prior Lake, MN 55372
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TYPE OF STRUCTURE.
1. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
Commercial
^-
Two-Family
Industrial
Public
Multi-Family
Other
Date
Fee Schedule
<J..- ..:5
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireolace
Ces)gential, Add~ions & Alteratio~
Residential, AC Only
~~Jl!i()~,cost ($39.50 minimum)
'--_. $99.50j
$64.50
$39.50
$39.50 1". 56 = ~O. 00
$39.50
Heating Contractor
Address
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jrr.....,..~.. ..1IIiit
Telephone #
Furnace Make & Model A~~33
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AIR CONDmONERUNITS CANNOT
ENCROACH INTO SIDEYARD SETBACKS.
The price of your heating permit includes one rough-in and one final inspection.
1S will be billed at $35.00 each.
Model Size
Cfm.
TYPE OF SYSTEM
Warm Air ptants _ REQUEST FOR INSPECTION
Gravity SENT TO HOMEOWNER 2/03.
Mechanical NO RESPONSE. CLOSE FILE
Air Conditioning_
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
Record must be submitted with buildinq Derm~ lli!!!l!lm: before build-
;upancy will be issued.
Conn. Loai .
Fuel f\.4f\ '1 reA FI~~
Supply Openings
Return Openings
Input I t;IO ) tP13utput
Edr.
~ REQUIRED with number of supply and return openings listed per
. .r opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
C~ Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Phone: (952) 447-9850
Fax: (952)447-4245
Atterations
TYPE OF WORK
Replacement X
(lo;:;n
Est. Cost $ :c:;.:s ~ Building Perm~ #
HEATING PERMIT FEE $ ~3r5"O
STATE SURCHARGE $ .50
TOTAL PERMITFEES $ {~ Receipt #
4<J .00
~
3Bh17
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.1 hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case ot..aJ1 work Whilc~==nd approval of Pla~~. (1 /6U
Apm1/lnature I ( . i*o. ()()
BUildii Ollical's Signature Date
Repair
Est. Comp. Date