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O CITY OF PRIOR LAKE
t~ o f ; 9 HEATING /AIR C ONDITIONING/FIREPLACE PLACE PERMIT Date Recd
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I. Pink File
Please ■C Or "nt 2. Green r;,,. PERMIT NO. /
and SI n at bottom 3. Yellow Applicant ' i —
ADDRESS
2 is 'l'�L�L r /1 ZONING (office use) id F
LEGAL DESCRIPTION (office use only) •
LOT BLOCK ADDITION
PM
OWNER
(Name) ii rri ♦r 4 (✓ _ "] �
(Phone) � 2 f � ' 4,
•
APPLICANT ot
(Name) :V. HEATING & AIR INC.
(Address)
51$2 V /EST BROAD ' (phone)
(Address) r. ' — ►) • • ,
763- 535 -2000 (City) (Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
APPLICANT PL ASE COMPLETE BELOW
•
[NEW CONSTRUCTION ►` PLACEMENT
FURNACE MAKE AND MODEL il v J c: ID ALTERATIONS
•
FLUE SIZE RETURN OPENINGS FUEL..
TYPE OF SYSTEM � �� � ��� OUTP T
HEATING OR POWER PLANT
►�"' arm Air Plants PLEASE NOTE: Air Conditioner
■Gravity 0
❑ Mechanical ❑ Hot Water Units and Fireplaces Cannot Encroach
tr Conditioning 0 into Required Side Yard Setbacks.
Vent. System ❑Special bevices Fireplaces with Box Additions or
❑Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL Require a Building Permit.
•
Industrial, Commercial & Multi-Famil y 1 /o o FEE SCHEDULE
of job cost Residential, Gas Fireplace
Residential, Heating & A/C $49.50 minimum $49.50
Residential, Heating Only (New C nst Construction) $64.500 Residential, Additions &Alterations
Residential, AC Only " 0
$49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes § 32613.148
.HEATING PERMIT FEE $ "SURCHARGE" has been changed for one
STATE SURCHARGE $ year effective
TOTAL PERMIT FEE July 1, 2010, until June 30, 2011.
(Office Use Only) ? The minimum , beginning for "fixed fee" permit
This Application Becomes Your Building Permit When Approved Paid ninl July 1.2ou)
�[1�j,� Receipt No. •
Buildine Official Date q j `� ��
G
MII
ate �-/ 443 BY /- A
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 -4245 /
4646 Dakota Street S.E., Prior Lake, Minnesota 55372