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o g PRIQ CITY OF PRIOR LAKE
,p = .BEATING /AER CONDITIONING/FIREPLACE Date Reed
_� - . __, ACE PERMIT
- 4 iiiwiasdo -
1. Pink Fite
'lease , e or .fine and si: n of bottom 2. orcta �,,• PERMIT NO. / /
ADDRESS, 3. Ye17oa• Applicant /� .
S � i ZONING f
(offi use)
LEGAL, D ESCRI P TION (office use only)
LOT BLOCK ADDITION
OWNER PID
(Name) .� �-' ,
(Address) ,��- , (Phone) 5 ' - . G3.53
APPLICANT
(Name) &' , '�. --c„/ -,,
(Address) / . ,/` �<- (phone) G � - 5",,.. - �� Ii
(Address} (--/ ''`.,/- h .'..."7--.--' 67-S7-3_5---2-.
(Contact Person s �- • cz/ (City) (Zip Code)
} /c'
APPLICANT SIGNATURE / � / (Phone) /y/ - j - /o
�� DATB�
APPLICANT PLEASE COMPLETE BELOW
[]NEW CONSTRUCTION
FURNACE MAKE AND MODEL rRPi'LACEMENT 0 ALTERATIONS
y r r ..." -1' l' 3..1'di./
FLUE SIZE RETURN OPENINGS FUEL /7c/��`-
TYPE OF SYSTEM INPUT or
�c7 G OUTPUT
[QWarm Air Plants HEATING. OR POWER PLANT
QGravity 0 Steam
0 Water
PLEASE NOTE: Mr Conditioner
C echatuca2 Units and Fireplaces Cannot Encroach
E•.' it Conditioning ❑Radiation into Required Side Yard Setbacks,
[Went. System ❑ Special Devices Fireplaces with Box Additions or
❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family 1% FEE SCHEDULE
Y l of /o job cost l ..
Residential, Heating & A/C Residential, Gas Fireplace
$ 149.5 p
minimum $49.Sp
Residential, Heating (New Construction) $749 S
g Only (New Construction) $6Q 50 Residential, Additions &Alterations
Residential, AC Only $49.50
Estimated Cost $ $49.50
Building Permit #
HEATING PERMIT FEE $ -i
STATE SURCHARGE $
(office Use Only) TOTAL PERMIT FEE $ 6-41
1 ,5,
5 '�
This Application Becomes Your Building Permit When Approved paid
Balldtne OfIlclal Date
Date -
24 hour notice for all inspections (952) 4 47L9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372