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CITY OF PRIOR LAKE Date [teed i.-, /1
HEATING /AIR CONDITIONING/FIREPLACE PERMIT 6. i , c" 9
r ,s.'
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21 . Pink n;en File PERMIT NO .0 OZ/4— . G Ci
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
k p G 1 I Rctf\t, e v\l' T)(' 5Lcu / \
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) N a. & & (Phone)
(Address) k k. 1\ 1 v 1 ei3 - Dr- 5 I x c Q m Lai I �5- 2
P r, —
APPLICANT
(Name) GENZ -RYAN PLUMBING & HEATING (Phone) 952- 767 -1000
(Address) 2200 W. HWY 13 BURNSVILLE 55337
(Address) (City) (Zip Code)
� (Contact Person) Uvt ,,� + j l e-. (Phone) "i �1 1 ID 1 "D' 1 � U V v
APPLICANT SIGNATURE t DATE g" 2 FS — U t
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ..22EPLACEMENT El ALTERATIONS, Lo t de. rr�.��
FURNACE MAKE AND MODEL � n X C -15 14 SEC. i � O k) - 1 L
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 or
,Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
❑Vent. System ❑ Other Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL l
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 ns & Iter ates $43.50
Residential, Heating Only (New Construction) $64.50 Rest ential, AC Only $49 50_
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ 1 -19 , 5
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ r 3 , CO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 50.0 Q Rec j'ff 0.5 77
Date /_ . ( U 7 By
Building Official Date W '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372