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T (O;. CITY OF PRIOR LAKE Date Rec'd
s ° � HEATING /AIR CONDITIONING /FIREPLACE PERMIT
, '=fi x
'frNNEso,t, I. Pink File PERMIT NO .
2. Green City & 0
3. Yellow Applicant / / - YL
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3344 S1'I
W
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER J gif (Phone) ( -/1'� T �4'" 6 I7. (Name) (Address) 3.34 (' & J t tE isi'I c.i,
APPLICANT ri "
�- A ( ( ) 7G3-S7�2 -X5
(Name) �-Q 1 �1/� Phone
(Address) 771 VA A ' �t�Qn VV • l' e • fa�llay sciaz
,y, r / / vt (City (Zip Code)
(Contact Person) j(A (Phone) 7&3- 5
N6
1
APPLICANT SIGNATURE I 41 1 . 1. J. J DATE _71Cldf
A 1 1 1 LICANT PLEA ` COMPLETE BELOW
❑NEW CONSTRUCTION 1:4 REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation
Air Conditioning ❑Special Devices Fireplaces with Box Additions or
Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
111%, 1V1I1111GJV16 JLQILLLGJ y JLU13.1•FO ' ost $ 7(10. w Building Permit #
"SURCH GE" has been changed for one
July ear e rve r e 5D
Jul 1, 20 ntil SE
June 30, 2011. ATING PERMIT FEE $
The minimum s c rge for a "fixed fee" permit ;TATE SURCHARGE $ 49--• 5. (/O
is . , begin • g July 1, 2010 COTAL PERMIT FEE $ .Q15144) 9I g
This Application Becomes Your Building Permit When Approved Paid - 6 z 3 , Rel o. (
Buildine Official Date Date 7 l / •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 110
4646 Dakota Street S.E., Prior Lake, Minnesota 55372