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4 vitr CITY OF PRIOR LAKE Date Rec'd •
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HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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t. z. teen 2:.,,, I. G P
�'^' 5 PERMIT NO. (, I ( 1
• 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I - la "),:9. U)IDS b u l - k - i au I N
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N� Veiikki.t)i IY Lc t d ( (Phone) 9); 416 — 5 •
(Address) r " •
APPLICANT Kline Corp.
(Name) DBA: Practical Systems (Phone) •
4342E Shady Oak Road
(Address) Hopkins, MN 55343
952 -933 -1868 (City) (Zip Code)
t 6 —
(Contact Person) K.) OCc -114' (Phone) x J
APPLICANT SIGNATURE s -bb DATE /4 - /
0 II
AP ' ICANT PLEASE 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
:Wane Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
DAir Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
1 Require a Building Permit.
FIREPLACE MAKE AND MODEL V—..0 { 0 q * `( 3L
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
Estimated Cost $ 3 (SiV — Building Permit #
The Minnesota Statutes *32613.148
HEATING PERMIT FEE $ 4 0 5 year has been changed I'or one
year effective
STATE SURCHARGE $ tJZSO July 1, 2010. until June 30.2011.
TOTAL PERMIT FEE 5 .5f 50 The minimum surcharge for a "fixed fee" permit
(Office Use Only) is , SS, beginning .lulu 1.2010
This Application Becomes Your Building Permit When Approved Paid �' 3 - 2 Recei . (0,4413
Building Official Date Date/0 ,5-4'
z, 4 , ! By
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -44245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372