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pRIO CITY OF PRIOR LAKE Date Rec'd
�, A � HEATING /AIR CONDITIONING /FIREPLACE PERMIT
'NNESO 1. Pink File PERMIT NO. y54-.
3 . YeIIo E
City NO. N 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 f To Ni/3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWN T& f lief +vl f l' (Phone)
(Address) . , --2 )1d1 E)i h k;lrk. yr0 "I v
APPLICAN '6 • A �b�� - ,`
(Name) / ‘-'t . t (Phone) ✓ L�� " I -. � �U 0
(Address) O 0 kf 13 W V - L/Ux^ IJ� �V .Q,. / v �` j4-
i dress) i (City) (Zip Code)
(Contact Person) L�.' f Ai ° A' i A \ (Phone) ja . . ( � c)
APPLICANT SIGNAT • - �—!� - /111j • _ .�..., --��41 , • E — 1 a
APPLICANT PL AS 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
['Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ M hanical ❑ Radiation
u 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
The Minnesota Statutes § 32613.148 ' ' ':ost $ 1 M) 1 i ' Building Permit #
"SURCHARGE" has been extended ;
until June 30, 2013, HEATING PERMIT FEE $ -1 1siD
The minimum surcharge for a STATE SURCHARGE $ L '"",53r
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 59 S0
This Application Becomes Your Building Permit When Approved Paid 5 / cv Rec . No. 6 41¢¢
Date q ` 2.1 i /
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372