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Building Permit 10. 0723
— 0 O 0 000000 7 0> Kg 0 0 0 0 § IK V a 3 0 m 2 - § n a 0 2q M A a E c 0 M 73 m qk %§ q m 0 m E "i z ® 11 n 0 2 $ ® ®b z c, t 0 \ j ..] 2 �. 0 \ of § \ z m m m \ k ` r c \ q X 2 111 1 ..G.... \ m 2 00 000000 % . \ - mm ��_� $ 71 �$§� . c c ) \ / \ 0 0 � } rn 0 ti, , k m 9 0 . @ r %RR z § F1 \ E 141/4 q 2 { 2 z§7 z r t 2 § m � r. � -0 g § / V § X 3 = m t q 0 (1)-- q . "`p1:10000 ` f o m \ 2 7 11; cn mI§§ C 2 ., mm ■ t R. o ® � �� z 0 4 ® m ® R 1 -I m _ 73 r rn � r 0 Rt $ s` S -% CITY OF PRIOR LAKE `/ Date Reed r o °4 =� HEATING /AIR CONDITIONING /FIREPLACE PERMIT 0. 25, ( 0 i.t, 4 iAtnESD0 is c e. r A , PERMIT NO. /0, '7 V 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) l 6 L' 1.a M kt.i R ANI k, r fi t::.) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) t 1 t L. F Z ee - LVI! ) (Phone) U a 1 - 1 O/ 5 (Address) t 3 MA,,i AJ ` 3 i 9:�t L -V. C - 5 539 : Z APPLICANT (Name) F i� A2rr< l -ItP' 1 % h ", tr, t ki L IV) t- • (Phone) _ — 4'CZ - 5`n- 1 I LAP (Address). "'I� PLY M )1 H /Uri. cNI . 6.4.tyW 0A.i_Lct."/ 5542 (Address) (City) (Zip Code) (Contact Person) &..tX Jt. y S L 1&5 (Phone) APPLICANT SIGNATURE ST).."..- --- - DATE ' --1 APPLICANT PLEASE COMPLETE BELOW ❑NEW CONSTRUCTION '54 REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL CA.RRI`tiZ f `-,j `Z3 M \f L© il,0 FUEL 4 A't11sZA i- FLUE SIZE e PVC, RETURN OPENINGS INPUT GO 1 000 OUTPUT 5i 1 03,_ 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 ❑ Radiation Fireplaces with Box Additions or Air Conditioning ❑ 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 I% 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 11 HEATING PERMIT FEE $ L4 Q .5 STATE SURCHARGE $ u 00 TOTAL PERMIT FEE $ S`-! : SO (Office Use Only) This Application Becomes Your Building Permit When Approved Paid _ / ,, --- 0 Re, No. 6 i 0 S Date �� Btllldine Official Date _ dif • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372