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i _ vRiO CITY OF PRIOR LAKE Date Rec'd
" HEATING /AIR CONDITIONING /FIREPLACE PERMIT /0 5 1
ti ,r } ` x a
41INNEsocP 1. Pink File PERMIT NO . /� �j
2. Green City / / . / / //_5
3. Yellow Applicant r V�/ ���....JJJ
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
l L\Tq 4 CO\Je AVenue SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( O IVa WNER I,I K \ O � ret rneA7 (Phone) q52
(Address) Igict4 Cole A e ve SE
-
APPLICANT , 7 G J I , �- - p�-� p� C
(Name) I�OYiS MenQX\1COS , in C• (Phone) ��J2 -` J g6 t 9
(Address) 12010 told - BY1GY-- "lard Rocxcil Sh,imPee S53/9
�
(Address) (City) (Zip Code)
(Contact Person) LI 1 'c1O (Phone)
APPLICANT SIGNATURE &Vft!. \ ■•_ c0 DATE J 0 4-1
II
APPLIC • NT PLEAS COMPLETE BELO
❑NEW CONSTRUCTION [: ' EPLACEMENT ALTERATION L.
1
FURNACE MAKE AND MODEL FUEL '' q
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.
❑ 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
In ustrial, Commercial & Multi - Family n
1•- 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
1 ne mumesota statutes 3 szots.145 St $ Building Permit #
"SURCHARGE" has been changed for one
year effective
July 1, 2010, until June 30, 2011. EATING PERMIT FEE $ .
The minimum surcharge for a "fixed fee" permit 'ATE SURCHARGE $ r 0(7.50
is $,, beginning July 1, 2010 )TAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid .�'1 SV Receipt No. 642
l y °'
Buildine Official Date Date 10 11 B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372