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PRr CITY OF PRIOR LAKE Date Rec'd
°�'� �� I3EATING/AIR CfJNDITIONING/FIREPLACE PERMIT � ` + ` ,� y �
,� �`��� �'�=�`:�
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; �fNNSSO�P � : '. , i. r��x F��� PERMIT NO . � -� � .�
• . 2. Green Cify �
� � l. Yello�v Applicaot � i' �'^'
lease e or ' t and si n at 6o[tom
ADDRESS r I C C� ZONING (o�'ice �se)
t-� ��C�C-���a.�� z-- � � �
LEG.AL DE TIUN (ofltice use only)
LOT B OCK ADDITION ` PID
o� c� c� oC �i�,� � . Ct 5(.??� 6 y'6 �5 �
(Name) �"*-�'�' (Fb6ne)
�Address} .
��e�� G.V. HEATING & AIR INC. (phone •,
�
)
(Address) CRYSTAL, MN 55429 �
�Ad�6S-535-2000 c��ri� t� caa��
(Conta.ct Person) ' (Phone)
APPLICANT SIGNATURE DATE
A PPLICANT PLEA E COMPLETE BELOW
[]NBW CONS�UCTION REPLACEMENT ❑ ALTERATIONS �
FURNACE MAKE AND MODEL �Ci �C � �� FUEL
FLUE SIZE RETURN OPENi]VGS INPUT U� OUT�
TXPE OF SYSTEM HEATING OR POWER PL�ANT .
arm Air Plants ,*.,<�:: p�.�E NOTE: Afr Cond�tioner
� S��az Units and Fireplaces Caanot Encroach
Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation ��eplaces with Boz Additiona or
� ir Conditioning ❑ Spccial Devices "
Yent. System ❑ Other Devices , Cantilevers to the Ontside of Buiidings �
Require a Bailding Permit.
FIR EPLACE MAKE AND MOD
FEE SCI�DULE
lndustrial, Commercial & Muld-Family I°/ b coat Residential, Gas Fireplace $49.50
49.5 nimum '
Residential, Heating & A/C (IVew Constructian) . 0 Residential, Additions & Alterations 549.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only �
Fstimated Cost $(.� 1�, � Building Permit #
Tlie Minnesota Statutes ,��' 326Q.148
HEATING PERMIT FEE $ ��� �� "SI;RCf-IARGF.;" hus been chungrd I'or one
yeareffective /, a � ?
STATE SURCHARGE $ `�• �� Jtil�� 1. 2lll(i, unti! ,1unc 3t1;'Z�Tl: �t� -�
TOTAL PERMIT FEE $ , Thc minimum sa�rcharge for a "Ii�M icc" permit
(Oflice l)se Only)
is S,,ti;, beginning ,f uty i. 201U
Thfs Application Becomes Your Building Perxuit When Approved Paid �,/ � C � Receipt No. � 5� U�
`T
Date � f -� By �l
BuildineOfficial Date � ' _ / �"' `�"`�L- �
2d hour notice for all inspecNons (952) 447-9850, fax {952) 4d7-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 5537Z