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CITY OF PRIOR LAKE Date Rec'd
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HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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4118-NESO,(p' 2 1. Y Pi enk File City PERMIT NO .
. 111 �/ &SO
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ffi
RESS _
./ ZONING (office use)
t /S0 1 cP r� ' s�-• sb
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N ) �A 1 J_5 nttl 1 I (Phone) (P Ic " 9/0- 19,3D
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(Address) i / a S , S
th
APPLICANT
(Name) (Phone) q ,, II
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(Address) Applian 31- 1815874
RgitC9nnections Inc (City) (Zip Code)
Circle (Contact Person) _ 1313 Danita (Phone) APPLICANT SIGNATURE O j @e/ N 53� i r DATE —1 in • 1
i I, : ■
—
APPLICANT PLE E COMPLETE 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
❑Gravit ['Hot Water into Required Side Yard Setbacks.
Mechanical iii Radiation
Air Conditioning I=1 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
ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one IEATING PERMIT FEE $
year effective .TATE SURCHARGE $ > . :) :RI'
July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit 'OTAL PERMIT FEE $
is S5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid 54 0 R eipt No. / „ J ? 4
lJ q
Date
Building Official Date i 7 t '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372