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' o � px1o� CITY OF PRIOR LAKE Date Rec'd �
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT � v �; . �..
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' �''^`� '� 2: � , �. h, PERMIT NO. � -Z ( Z (
� 3. Yellow AppHcw i
� ease or ' t aad si at botb�m
� ADDRESS ZONIl�TG <oe� ��
' I� Ce vC.P '�i r� 1� �
LEf�AL DESCRJPI'IUN (otT'ia use only)
LOT BLOCK A.UDITION PID �
�r�_�'-� c�, � �D�- ��e� 1� -`�'�� ' F 33� �
�,�� _ ��37�. :
APPLICA1vT Kline Corp. �
��e� DBA: Practical Systems
43426 Shady Oak Road �
(Address) Hopkins, MN 55343
�Aa, 952-933-1868 � a.,D� �r� c�' �°a�)
(Contact Persan) � � _ _
APPLICANT SIGNATt7RE DATE lU' ��'/�
APP C PLEASE COMPLETE BELOW ,
[]NBW CONSTRUCT[ON ❑ REPLACEMENT (�;ALTERATIONS :
FURNACE MAKE AND MODEL FUEL
FI,UE SIZE RETURN OPENINGS INPUT OUTPUT •
TYPE OF SYSTEM HEATING OR POWER PLANT .
[]Warm Air Plants pLEASE NOTE: Air Conditioner
� S�ea�'°' Units and Fireplaces Cannot 1:ncroACh
❑Graviry ❑ Hoc Water �� g� 5ide Yard Setbacks.
� Mechanical ❑ Radiation �eplsces with Boz Additions or
�Aer Conditioning ❑ Special Devices
�venf System � ��. �,�� Caatilevers to #6e Oatside of Buildings
Require � BaiMiag Permi�.
FIREPI,ACE MAKE AND MUDE[. � L�
FEE SCHEDULE
Industrial, Commercial & Multi-Family I°/a of job cost Resi�ntiat, G� Fireplace ��49.50 '
$49.SQ minimum
Residential, Heating 8c A/C (New Construction) �149.50 Resideritial, Additions 8c Alterations 549.50
Residen6al, Heating Only (Ncw Constructian) a64.50 Residential, AC Only $49.50 .
\
Eadmated Cost $ ' Building Permit # '
,/ Tl�e Minncsotu Suitut�c � 326(3.l48 .
HEATING PERMIT kEE $ `� y s� "S�RC:I�iARGF.;" has been ehanEed 1'or one
L yctar effcctive
STATE SURCHARGE $ u. . 0 Jtd�� 1, 20fU, uuti! Junc 3i), 2U1 I.
TOTAL PERMIT FEE $ Tdc minimum surchar�e for a"Rxal [ce" permit
(OPBce Ua Only) is,4,,',,�, be�ianin� Jply 1.2010
This Applicatioe Becomea Your Building Permit When Approved Paid �� � Receigt Na� �� �
Bailding Official Dabe Da �� U . �� • � �- � ,
24 hour notice for all inapectiona (952) 447-9850, fax {952) 447-4245
4646 Dakota Street S.E., Prior I,ake, Minnesota 55372