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PR CITY OF PRIOR LAKE Date Rec'd
° ' ;�c HEATING /AIR CONDITIONING /FIREPLACE PERMIT
�iNNESOP I. Pink File NO. / _ Z5
2. Ye PERMIT NO
Yellow City / I y l0
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5519 Crossandra Street SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) John Merry (Phone) 952- 440 -2302
(Address) 5519 Crossandra Street SE
APPLICANT
(Name) Apple -Lake Heating & Air Conditioninghone) 952- 431 -4328
(Address) 207 150th Street W. Apple Valley, MN 55124
(Address) (City) (Zip Code)
(Contact Person) Beth Janohosky (Phone) 952 - 431 -4328
APPLICANT SIGNATURE ,. � LI DATE 7/8/11
•
APPLICANT PLEASErMPLETE BELOW
NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
Mechanical ❑Radiation Fireplaces with Box Additions or
it Conditioning Carrier 3 tOn ❑ Special Devices
❑Vent. System El 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 (Re y
sidential, AC Only)
, ost $ $49 . 5 0 Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one HEATING PERMIT FEE $
year effective
July I, 2010, until June 30, 2011. STATE SURCHARGE $ $5.00 .
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $54.50
is , beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid S - Re r No. / 733
Date (7 // : y
Building Official Date i.
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 I
4646 Dakota Street S.E., Prior Lake, Minnesota 55372