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o CITY OF PRIOR LAKE Date Rec'd
a HEATING /AIR CONDITIONING /FIREPLACE PERMIT 4 , 1 j 3
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Q. A �. 1 . Pink File PERMIT NO .
�In'NESO� V 2. Green City /3 //4_,
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS / 5 7 3 3 Is ( V; ew 800..1 N (..t) ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) WNER `0 t c i f■ - - 6 Cesa-LC. (Phone) 462 `YY a • 3 d !p
(Address) / 5733 a5 (t,..",cI Vi R?, N co Pr i c,- Lec ke ,?J N 6S 7
APPLICANT
(Name) CenterPo nt Ener y_ (Phone) 14„3- - 7 TS s'7 6 4 (
Suite B
(Address) ..•.a • - 13
(Address) (City) (Zip Code)
(Contact Person) -...3*-; A 11 . V\ ke /~ (Phone) `? Lo3 - 7 YS -5%'o'7
APPLICANT SIGNATURE 14 ti . /ti ii _ i i. DATE •ei /i
I
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION (REPLACEMENT ❑ ALTERATIONS / /��J �
FURNACE MAKE AND MODEL - �..r t 5' P 4_0 $U` 1 - 1'1 FUEL Na-F . Ca S
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
Gravity ❑ Hot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation
Fireplaces with Box Additions or
❑Air Conditioning ❑ Special Devices
['Vent. System ['Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
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
"SURCHARGE" has been extended ost $ Building Permit #
until June 30, 2013, c 0
The minimum surcharge for a {EATING PERMIT FEE $ 5
"fixed fee" permit is $5.00 ;TATE SURCHARGE $ 6i 00 :59-
i OTAL PERMIT FEE $ SY SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid CAZA ` ,' n ) Receipt No. / _ v L i
Date, K �
Building Official Date ! I 1 f 3
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372