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• .. I) Rlo CITY OF PRIOR LAKE Date Rec'd
� ° ,050 , e HEATING /AIR CONDITIONING /FIREPLACE PERMIT 7 l l
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41lMvssol-t I. File
Green 2. Green ` PERMIT NO. / (D
3. Yel Applicant
(Please type or print and sign at bottom)
ADDRESS ,! / 46 .5
ZONING (office use)
■
$! l J/ CJrod 4
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID & o ua? , 6 ( 2-„O
OWNER —I /
(Name) cJ ii LAil'►.G" (Phone) C /2 - . (e 7' .0
(Address) 55 ? / %i i0 )4 L Q
APPLICANT A /1 ___, !/
(Name) re" /1_ A I _:i / ' Ail, (Phone) T.� - Y®- 7/g ii
(Address) 73-07 R /r Chi , fts ,53-
3/ 7�
/ (Address) (City) ����,�� (Zip Code)
(Contact Person) eft , ' (Phone) 9p - %vi /79,.-
APPLICANT SIGNATURE DATE `7 /
/
APPLICANT P .. A • ' COMPLETE BELOW
NEW CONSTRUCTION aREPLACEMENT ❑ ALTERATIONS
it.1.&I .//��� CE MAKE AND MODEL Cate/ ir_f a9'�11T6,30/ - O(b 0 t /O 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 ❑ Radiation Fireplaces with Box Additions ;StAr Conditioning ❑ Special Devices
['Vent. System L3 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 CTO
Estimated Cost $ ,3 Building Permit #
"fhe Minnesota Statutes `S 326B.141t
HEATING PERMIT FEE $ "S(-RCI IARGI:" has been changed for one
Year effective
STATE SURCHARGE $ .50 July 1, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ - -File minimum surcharge for a "filed fee" permit
(Office Use Only) l — is S ginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid 5 1 i D . - pt No.63Jr
Building Official Date Date.- / / // 1 y '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372