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� i�xr CITY OF PRIOR LAIKE Date Rec'd
�°; y '�',� I�EATING/AIR CONDITIONING/FIREPLACE PERMIT
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�� I. I'ink File pERMIT NO •
' 2. Cneen City / �
I � 3. Ye1law Applicaot r
Please e or 'nt and si n at boEtom
' f1DDRESS ' ZONING (otfi� n5e}
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LEGAL DESCRIPTION (ot�ice use only)
LOT BLOCK ADDITION PID
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(Na } �°_. .tJ�.�US� I '� �O Yli�► S (Phone) . - 1�J2.' � "' �od ( ` :
(Address) .
APPLIC , .
(Name). � (?1�'YU,�(�1� }�C[�l�" � l I� �' �71.c.1/tA (Phone) �'S 2 - � g � - 355 'L
(Address) � � D � � - I �.�`� S�'- � � bYYU, rl.q� � J�� �.-�
(Address) (City1 (Zip Code)
(Cantact Person) �� �� QaG"c� (Phone) �S a g$ 4 355 2
APPLICANT SIGNATURE `� DATE Z'rZ'l Z-
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APPLICANT PLEASE CQMPLETE BEL4W �
QNEW CONSTRUCT[ON REPLACEMENT ❑ ALTERATIONS �
FURNACE MAKE AND MODEL �/ V'i e li" SQTpS Ar I 0� FUEL Y10.�' l,l�/'a� � QS
FL,UE SIZE 2�� RETURN OPENINGS INPUT I � �,�� OUTPUT ��O � 7(?
TYPE OF SYSTEM HEATII�TG OR POWBR PLANT ,
❑Warm Air Plants PLEASE NOTE: Air Condiiioner
❑ Sceam Units and l�'ireplaces Cannot Encroach
❑Gravity ❑ Hot Water
❑ Mechanical ❑ Radiation into Required Side Yard Setbacks.
❑Air Conditioning ❑ Spcciai Devices Fireplaces wifih Box Additione or
❑Vent. Systexn ❑ Other Devices Cantilevers to the Ontside of Buildings
Require a Build�ng Pera�.t.
FIREPLACE MAKE AND M+QDEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of}ob cost Residentiat, Gas Fireplace $49.50
$49.50 menimum
Residential, Heating & A/C (New Cflnstruction) $144.50 Residential, Additions & Alteratians $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
'The Minitesoia 5t�tutes � 32G[i.148
HEATING PERMIT FEE $ L�. Cr, �j'� "SI.�RCI-IARCiF.;" h�as been chunged I'or one
vear effcctive
STATE SURCHARGE $ 5.00 -38� , 1ii1�� 1, 2llfij, ut�ti! J�cnc 3(► zt►� �.
TOTAL PEItMIT �'EE $ ej�{-• 'rj () 7'hr niiniiaum s�irchTr$c for a "fi�ec! fcr" permit
(OFfice Use Only) is ��*, h_�tiinningJuly 1.201U
This Application Becomes Your Buildfng Permit When Approved Paid ��-� �-� Recei t o. ��
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Bufldine Official Date --° Date �,� �� B I
24 hour notice for a11 inspections (952) 447-9850, fax {952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372