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� 9 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�rNNESO�P �. r�,� F»e PERMIT NO
2. Green ciry ' �� � � /�
3. Yellow Applicant ����
ease e or ' t and si at bottom
ADDRESS �ONING �o��,��
16479 Five Hawks Ave SE
LEGAL DESCRIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID
� R ELAINE WHITE (Phone) 952•-440-3423
ame
(Address) 16479 Fiv� Hawks Av` SE PriQr Lake �N 55372
APPLICANT
(Name) CENTERPOINT ENERGY (Phone) 763-•785--5404
(Address) 9320 EVERGREEN BLUD NW SUITE B, COON RAPIDS, MN 55433
(Address) (City) (Zip Code)
(ContactPerson) _;)OANN ZINKEN (Phone) 763�785�5404
APPLICANT SIGNA DATE
APPLICANT EASE COMPLETE BELOW
�NEW CONSTRUCTION OX REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL C�.rri er 58CTA070 FUEL h3tural gas
FLUE SIZE RETURN OPENINGS INPUT 70 . 0006T11 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
Gravity ❑ Hot Water
into Required Side Yard Setbacks.
Mechanical ❑ Radiation
Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
ent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
PJ �.. ��,(�'r�+PJ(� a�'R Lg FEE SCHEDULE
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
The Minnesota Statutes § 326B.148 Cost $ Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, HEATING PERMIT FEE $ �'`' � . �/���� 9'
The minimum surcharge for a STATE SURCHARGE $
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ �j
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid ��� Receipt No. `�� /,
�v ,5 ���.
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