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P RI CITY OF PRIOR LAKE Date Rec'd
° e' HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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4 1j/V NES p 'SQ' . /
2I . Gr Pink File /` een e1ty PERMIT NO. . (.Z¢
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 5 • - . J ^ � gar' ZONING (office use)
LEGAL DESCRIPTIN (office use only)
LOT BLOCK ADDITION PID
((Name) I' de/1 L _ & rfl ? (Phone) c152
(Address) 6512 Wooclod e goad
APPLICANT
(Name) � l ,Ohf O/ U Onf ! I V UJ (Phone) (41 ' 7 /
Phone
(Address) 1 Y 1. / / f 1 i /1 (0 t 1 EE0
(Address) �I (City) (Zip Code)
(Contact Person) _ / .CA� Ci (Phone) /'
APPLICANT SIGNATURE g 1 u DATE II u
' APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION K REPLACEMENT ❑ 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 El 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
i uc IVIIIIIICSUla JtututeS g hurt. i'+o ' Thst $ Building Permit #
"SURCHARGE" has been changed for one
year effective
July 1, 2010, until June 30, 2011. - EATING PERMIT FEE $
The minimum surcharge for a "fixed fee" permit ;TATE SURCHARGE $ .50
is S5, beginning duly 1, 2010 COTAL PERMIT FEE $
-,•i_ _ .. et .. ... . .... . . ... .._.. a ���n i eo
This Application Becomes Your Building Permit When Approved Paid ,. 6- 4 1 co Rece No. /
Date
• y By
Buildine Official Date / , 7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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