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t ' P RIp CITY OF PRIOR LAKE / Date Reed HEATING /AIR CONDITIONING/FIREPLACE PERMIT
x r=, 1 4 , NEso° rGreen C Fi it l e y PERMIT NO. / / ( Z
.
3. Yel Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
53c3,5 ly`O* s WE F?i'or La Kr
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) V J l t 1 L I / f (Phone) r ))
(Address) r 355 ( LK34/ 5f WE e La 55
PLI'4 hani ,, (I'1() ( qL � t 5 r Phone r
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(Address (0 01 61 e��( t � TaI 1✓l C WI (Address) i Code)
11'1l ( ) ( 4 5 € )
(Contact Person) (Phone) ' t 5
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APPLICANT SIGNATURE 1 . • . Y\ DATE
0
APPLICANT PLEASE COMPLETE BELOW
ANEW CONSTRUCTION Er Q ALTERATIONS
FURNACE MAKE AND MODEL t.tivi Aix ` 3,6 C -0- F FUEL
FLUE SIZE RETURN OPENINGS INPUT & iOn OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
['Gravity 0 Hot Water into Required Side Yard Setbacks.
Q;fechanical Q Radiation
Air Conditioning ❑Special Devices Fireplaces with Box Additions or
['Vent. System 0 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
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ - 1. 5 .
STATE SURCHARGE $ ARO .50
TOTAL PERMIT FEE $ ;M:
(Office Use Only)
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This Application Becomes Your Building Permit When Approved Paid 5 v o ii No. MI
Date � / f r
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 '
4646 Dakota Street S.E., Prior Lake, Minnesota 55372