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4 v itr o CITY OF PRIOR LAKE Date Reed
° ' HEATING /AIR CONDITIONING/FIREPLACE PERMIT
7 3/. 0 7
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41IhNEso 1. Pink File
2, Own can PERMIT NO. 69 057 5 - "' 575
3. Ycllow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
,S 99/ 8 r00 k_s C.. i rc__I S F
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) R 0 * -C \ ()I 6 'r J (Phone)
(Address) S 'iti I IS r o 0 L5 �.� r t? l L S
APPLICANT
(Name) L 4 — S c ' ) Gka r , G ci.' (Phone) ‘ _3 a Fs" a Q E
(Address) ARO0 MvlL ig. L. v /1/:gn gi°r►4-6 in P1 SS,3c3
nn (Address) (aty) (Zip Code)
(Contact Person) i�' 1 14 hk_ 1-k L B'� r ry (Phone) . 3 a - U 6
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APPLICANT SIGNATURE AZ— ' / . DATE 7 / 8 / ° 9
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION TA. REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
`Warm Air Plants ❑ Steam PLEASE NOTE: Air Conditioner
f Units and Fireplaces Cannot Encroach
❑Gravity ' ❑ Hot Water into Required Side Yard Setbacks.
Mechanical 11 Radiation
Air Conditioning ❑ Special Devices _ Fireplaces with Box Additions or
❑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 549.50
549.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations 549.50
Residential, Heating Only (New Construction) $64..50 Residential, AC Only 549.50
Estimated Cost $ S° 00 Building Permit #
HEATING PERMIT NEE $ L i 4i Sa
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ \S O 00
(Office Use Only)
■
This Application Becomes Your Building Permit When Approved Paid • • ipt No.
BttlldineOfGcial Date Date 3 / / oy
ty
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 110 .
4646 Dakota Street S.E., Prior Lake, Minnesota 55372