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P RIO CITY OF PRIOR LAKE Date Rec'd
AP I k HEATING /AIR CONDITIONING /FIREPLACE PERMIT
- A�
, Ill
INNESo�¢ 1. Pink File
2. Green City PERMIT NO . /// / O 9/, 3
3. Yellow Applicant ! {!/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
4135 Colorado Street S.E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Jennifer Deschaine (Phone) 612- 619 -8797
(Address) 4135 Colorado Street S. E.
APPLICANT
(Name) Apple -Lake Heating & Air Conditioning (Phone) 952- 431 -4328
(Address) 207 150th Street W.
(Address) (City) (Zip Code)
(Contact Person) Be th Janohosky (Phone) 952 -431 -4328
APPLICANT SIGNATURE � �� '- - .: - , t• _- -DATE 10/11/10
APPLICANT PLEASE PLETE BELOW
[NEW CONSTRUCTION ® R LACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN 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 El Radiation Fireplaces with Box Additions or
72 it Conditioning ,' _ � N c, N. ❑ 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 449 SQ..:
Residential, Heating Only (New Construction) $64.50 Residential, AC Only 49.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ -k. 1 .. s ' -
STATE SURCHARGE $ 5_‹..- :59--
TOTAL PERMIT FEE $ <; \ .5_
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 4 Receipt No. /6 /7
Buildine Official Date Date /0 i O / i) B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372