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4 p R f0 CITY OF PRIOR LAKE Date Rec'd
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k e HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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r 1. Itinile /z -
��NNESO� 2. Gre F en City PERMIT NO.
1 3. Yellow Applicant
(Please type or print and sign at bottom) _
ADDRESS ZONING (office use)
ID C I O 54 -t11\ f )0 . 0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIDZS – _ . 2367, 01 0
awNER V1, C� r>_ hb (Phone) ,
C I J L C 1� v
(Address) q () t 0 1 J I / t ) 0 , t J
APPLICANT G.V. HEATING & AIR INC. •
(Name) 5182 WEST BROADWAY (Phone) •
(Address) CRYSTAL, N 55429
(Addr 3 -53 - 00 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE :- ' DATE MI n ---
APPLICANT PLKA COMPLETE BELOW
DNEW CONSTRUCTION / PLACEMENT 0 ALTERATIONS
�
FURNACE MAKE AND MODEL tv�ck (7 (PI Il IP V G2OL " \ ■ ■ FUEL lam/
FLUE SIZE RETURN OPENINGS INPUT Oil 000 OUTP
I
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.
❑ echanical ( El Radiation
tCir Conditioning 'D - -m f;'1 A � ❑ Special Devices Fireplaces with Box Additions or
[Went. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% 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 $ Building Permit #
'file Minnesota Statutes ` 32613.148
HEATING PERMIT FEE $ "SI. ;RCI 'AWE" has been changed for one
year effective
STATE SURCHARGE $ t , July 1, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ (,u ` 5 0 The minimum rli rge fo r a "ixed J l� is � so btu c *inning •fnh I 2010 fee" permit
(Office Use Only) ^)
•
This Application Becomes Your Building Permit When Approved F Paid � _ � 6 p Rece o. 6 -7
Date
Building Official Date I / /3 1 1 By
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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