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CITY OF PRIOR LAKE Date Rec'd
( 4 > \ CONDITIONING /FIREPLACE PERM a9'i0
Q1 C . ;--"ieggiv c 11
` NES o`s 1. Pink File PERMIT NO.
2. Green City
3. Yellow Applicant O `+o
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\clr — 1L r F \ _h Cu V..c .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER l
(Name) t \ Nt. t ,t` mi l, 1 ti - (Phone) Cot rT - l G _0'. 3CY d.'
(Address) V`, c hC)\1\ rP A( 1Z._r E i 1 \1''l t (- N. kn 3<31
APPLICANT " .1PNSVILLE HEATING & A/C, INC. �' C L `a
(Name) (Phone) 1 2 - t C C('. j
3451 W. Burnsville Parkway
(Address) Suite 120
// �� BurnsvvI &dam 55337 (City) (Zip Code)
(Contact Person) V 1 V - AO (Phone)
APPLICANT SIGNATURE 6 L1')0 L- P c Orni.--/NC) 71 DATE 'S (}
^ — t
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 1 REPLACEMENT ❑ ALTERATIONS
I n Tn,. A AND l DDEL , , _ " , - _ 7 • l ( 4 Fti-EL
FEE RE - OPENI GS INI`HT 6F}T 3-T
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
' Conditioning R It ti.p.w0" ❑ Special Devices
E Vent. System ' 1 . t.o t� Other D evices / ❑ 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 $ (C{ < C Building Permit # The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one
year effective
HEATING PERMIT FEE $ 7. 5 July 1, 2010, until June 30, 2011.
STATE SURCHARGE $ 5 CC The minimum surcharge for a "fixed fee" permit
TOTAL PERMIT FEE $ 5-- y. is $5, beginning July 1, 2010
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid • m c Recei t No. / a e
Da B
Building Official Date t V ' q' to o
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372