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0 v Rr CITY OF PRIOR LAKE
Date Reed
4.• 0 HEATING /AIR CONDITIONING /FIREPLACE PERMIT
I • h% ESO „P I. Pink File PERMIT NO. ,3_
2. Green City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
n —'-- I - ' \} ■
•
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ---r— ',51C_.0. R1(0 \(c, (Phone) lQ 1 ` ac-A_U ” IR-55 •
(Address) 1 F 41-ca ,ef.S � inraNi (2.-,‘\r S\I .
APPLICANT
(Name) k 8_, A A , • a (Phone) LP 1r3 - S - 'G0C)\ •
Benjamin Franklin Plumbing •
(Address) The Punctual Plumber
(Address) 1414 ,ird street N (City) (Zip Code)
Minneapolis NIN 55411
(Contact Person) A ■ a Jams ■* (Phone) LQl 3- C 355-01 3
APPLICANT SIGNATURE iill i7�L 1 k,_ DATE I - P 13
' APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION 1tEPLACEMENT J ALTERATIONS
S FURNACE MAKE AND MODEL C
"� / g-} l v l ,� s lZDl_.P �A� �'V FUEL l`7"� C�s�
FLUE SIZE
Li /1 RETURN OPENINGS O� INPUT (POI COD OUTPUT 4 1 (
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
0Gravity ❑Hot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation q
Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
❑Vent. System ❑ Other Devices
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 $ 3 i �j ( Th Building Permit #
The Minnesota Statutes *326B.148
HEATING PERMIT FEE $ LA 5C) year has been changed for one
year ef'f'ective
STATE SURCHARGE $ .50 July i, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ . The minimum surcharge for a "fixed fee" permit
(Office Use Only) is +5, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No. f / d 3 e l
By
Date l/ i/ iAt.&
BuildinE Official Date
a
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372