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((pRi CITY OF PRIOR LAKE Date Rec'd
e. HEA TING /AIR CONDITIONING /FIREPLACE PERMIT
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41-ti'NEsoi' 1. Pink File PERMIT NO
2. Green City / T
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\u 5 g 0 Sl (r ` e L - �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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(Na WNER 'A it 1 Zaw 1 OC (Phone).'l)� " `a ����.J
(Address) \`- 5 O a. c _ PC \JJ V ((i b . l� 553-7 j
APPLICANT BURNSVILLE HEATING & NC, INC G(^�� `` II
(Name) (Phone) `���� �`'1 — ��
3451 VY. Burnsville Parkway
(Address) Suite 120
Burnsville, MNd5543( (City) (Zip Code)
(Contact Person) . ; A • (Phone) I I
APPLICANT SIGNATURE tit & f L ,, ' l f I DATE 0/3111
APPLICANT PLEASE COMPLETE BELOW
Ne..._ ❑NEW CO STRUCTION REPLACEMENT l ❑ ALTERATIONS
'FURNACE MAKE AND MODEL 111 ( 2 ' )f O ti It 1 ) 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.
H A Mechanical El Radiation
it 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
v ° *;•^° * °r cost $ Building Permit #
The Minnesota Statutes § 326B.148 1
"SURCHARGE" has been changed for one SEATING PERMIT FEE $ 4 `s
year effective ;TATE SURCHARGE $ SW
July 1, 2010, until June 30, 2011. FOTAL PERMIT FEE $ 5LJ , SO
The minimum surcharge fora "fixed fee" permit
is S5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid Ti , 3 V RI o. 6 74b6
Date / 0 / 0 By
Buildine Official Date i •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372