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( RI CITY OF PRIOR LAKE Date Rec'd
� IL
��e HEATING /AIR CONDITIONING /FIREPLACE PERMIT
M
�` 1. Pink File / � /
/nNES° 2. Green city PERMIT NO.
3. Yellow Applicant ‘ 7,7b
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3S1 D'` 1 - Si SCid
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
° Wa rne R WQ d kx ' V ( Phone) (Q1). -q_c; KIS
(Address)' 1) \ -- )v Si S . ?i\br ( , f "u \ L- ,- J Z
APPLICANT BURNSVILLE HEATING & A/U, INC
(Name) 3451 Burnsville Parkway (Phone) 0 tSZ GL/ C•005
Suite 120
(Address) Burnsville, MN 55337
E , ter\ (Address) (City) (Zip Code)
(Contact Person) �1 l (Phone)
a na_bilusnix.)., APPLICANT SIGNATURE 1 DATE ' `[ — `' _ji
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION gi REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL 3tS \ Ca (PO FUEL ,
FLUE SIZE RETUR OPENINGS INPUT 40 0,00 OUTPUT r di
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
it Conditioning ❑ Special Devices Fireplaces with Box Additions or
Went. System 0 Other Devices Cantilevers to the Outside of Buildings
_ Require a Building Permit.
... .. - • S' , - - >: PA... . 01 . .. A t IX 1 1 I,. ton
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 § 326B.148 Cost $ Building Permit #
"SURCHARGE" has been changed for one
year effective HEATING PERMIT FEE $ 4 Cl
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ 5
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ ap
is i& beginning July 1, 2010 '
This Application Becomes Your Building Permit When Approved Paid A-- s-7-) Rec o. 63S/5
p
Date / i / By '
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