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� p RIO CITY OF PRIOR LAKE Date Rec'd
F �� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� �
�I�'NES��P �. P�,� File PERMIT NO /A
2. Green City • �Z � / ��
3. Yellow Applicant �'
Please e or ' t and si at bottom
ADDRESS ZONING (oHt'ice use)
3s�1� s1 � ' �1 w
LEGAL DESCRIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID
�aWNER � \_JLV � \J�—� �.c (Phone) �PS ( � Zg 3- � 253
(Address) � U�� t �� �, � 2.
APPLICANT
(Name) �3URNSVILLE HE�,71NG &A/C 1NC. (Phone)�S2 ���
3451 W. Burnsviile �arl;w�y
(Address) ��+;�,�� �
Burnsville,����337 cc�ty> (Zip Code)
(Contact Person) (Phone) � �
APPLICANT SIGNATURE DATE ���'� I
APPLICANT PLEASE COMPLETE BELOW
�NEW CONSTRUCTION �REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL a�j I� FUEL ���
FLUE SIZE RETU OPENINGS INPUT OUTPUT
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
Air Conditioning ❑ Special Devices Fireplaces with Boz Additions or
❑Vent. System � Other Devices ��/ Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEESCHEDULE
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
��+;.,,.,.oa rost $ Building Permit #
The Minnesota Statutes § 326B.148 ,
"SURCHARGE" has been extended KEATING PERMIT FEE $�-�, ,S�
until )une 30, 2013, gTATE SURCHARGE $
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ �;��
This Application Becomes Your Building Permit When Approved Paid�� � Receipt No. /� ,/
�o �".
Date� By
Buildine Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372