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�� R� CITY QF PRIOR LAKE vate Rec'd
' °� ����' '�� HEATING/AIR CONDITIONINGCFIREPLACE PERMIT
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; '7fh t. i'ink �i� PERMIT NO •
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j 3. Yetlove Appticeot
' Flease e or 'nt and si n at bo[tam
' ADDRESS ZONING (oee�e use)
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LOT BLOCK AI?DITION PID
OWNER _ �
(Name) (Phone) �Z-ZZb- 3 2-�4'
(Address} :
N ARTH & HOME TECHNOLOGIES INC. •
APPLICANT dba FIRESIDE HEARTH & HOME
{Name) Lic. 6CO512060 (Phone)
2700 FAIRVIEW AVENUE N .
{Address) ROSEVILLE, MN 55113
tA��) 651.633.2561 (cnyl (z� coa��
(Contact Feison) �iU� (p�pne) � lZ 6 3-� i� S :
APPLICANT SIGNATURE ���� D�'j'g l l'� 2 �s �! 2J
APPLICANT PLEASE COMP'LETE BELUW
QNBW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS •
FURNACE MAKE AWD MODEL FUBL
FC.UE SiZE RETURN OPENIIVGS INPVI" OUTPUT
TYPE dF SY'STEM HEATING OR POWER PLANT ""' ,
[]Warm Air Flants PLEASE NOTE: Air Conditioner
❑ Steam Uni#s and Fireplaces Cannot Encroach
�� xity ❑ Hat Water into Requ�ed Side Yard Setbacks.
echanicai ❑ Radiation
�Air Conditioneng ❑ Special Devices �'ePlsces wit6 Bog Additi�ns or
�Vent. system ❑ Other Devices C�ntilevers to the Oatside of Buildings �
Require a Baild�ng Permit.
FiREPLACE MAKE AND MODEL �' F �%30�G l�d�li
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residsntial, Gas Fireptace $49.50 �
$49.SQ minimum
Residential, Heating & A/C (New Cflnstruction) �149.50 Residential, Additions & Aherations 549.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $a9.50
Fstirc�ated Cost $ �(000 Ob Building Permit #
9'he Minnesata Stalutes � 326Ei.l�t$
HEATING FERMIT FEE $ "St}RCFtr1RGF" has t�een chun�ed for one
yenr eff'active
STATB SURCHARGE $ .50 Jtil�� �. Z�)ttt vretit ,i�inc3i) 2ot I.
T�TAL PERMTT FEE $��. 6 D 7'hr minimsm surcharre for a "Rxect fec" permit
(O}� �� ��,) is ;,.-�y be�innin�J, �fy 1. 2iliU
__._ _ __ _ _
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This Application Becomes Yoar Bailding Permit When Apgroved Paid �' /� Receipt IVo. � D
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Bullding (Nticisl D'te �te / � " By �%k►L�
rs
24 hour notice for a}I inspertioas (952) 44T-9850, fax {952) 44T-4245
4646 Dskota Stre�t S.E., Prior Lake, Minncsota 55372