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( P RI CITY OF PRIOR LAKE Date Rec'd
uil i " �v HEATING /AIR CONDITIONING /FIREPLACE PERMIT k
' M
I ,,, ,,A 1. Pink F PERMIT NO .
2. ' Zen City / / -
3. Yellow Applicant r ( .,�
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\ lam a1l8 c U L43 o SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) �p u: -Ci (Phone) Ci
(Address) \ ) lu.l.,c Dr SE , ?u Irt_k_Q . l a
APPLIC /� � � (^�� ` r �r
(Name) �� � q AC (Phone) 0 I��- <c-t c .l
(Address), N51 W & t,LAO A 4 I)- 0 hil rtorit 1k 5533
(Address) (City) (Zip Code)
(Contact Person) t tACA (Phone)
APPLICANT SIGNATURE Pal f C � l aDnC DATE — 1 — 1 - / 1
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION [„REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL y' 3` -E LI J&() I00 FUEL orkf Clci/3
FLUE SIZE RETURN OPENINGS INPUT \},0 xJD OUTPUT et.C-
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
g G ravity 0 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
t ne ivitnnesota statutes 32t ts. t41s Building Permit #
"SURCHARGE" has been changed for one t �-�
year effective 'ING PERMIT FEE $ l L C� + 3 v
July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit E SURCHARGE $ S.CC
is is beginning July 1, 2010 ,L PERMIT FEE $ SCA SC)
This Application Becomes Your Building Permit When Approved Paid — ft N004 71
? 2 (/ny 1
Building Official Date Date� r / v
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372