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CITY OF PRIOR LAKE V Date Rec'd
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( g p HEATING /AIR CONDITIONING/FIREPLACE PERMIT /Z,(2, 6f
ji'NESDc I. Pink File PERMIT NO . n
2. Green
llo City / 0 co
3. Yellow Applicant (./ `
(Please type or print and sign at bottom)
ZONING (office use)
iz ,U I10 ►AJ LAI
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
(N ) ANT L 4 iJ mac/vial-1 (Phone) q 5:." -4 j t
(Address) &IV WI // OtJ 1--A1 Pr10 v - Lake_ 53 1 Z
Address) (City) (Zip Code)
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(Contact Person) (Phone) `/
APPLICANT SIGNATURE DATE /2- i/ / O
APPLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL 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 or
❑Air Conditioning ❑ Special Devices
[Went. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL /leak q 410 6 OQ) At-4
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 $ / Ut/• Building Permit #
HEATING PERMIT FEE $ *9 . s
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ -.57) 1 OD
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 57) t Vt..) Re e ' No. 5
Date
Building Official Date r B
i/ 2 , ci ,
. 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
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4646 Dakota Street S.E., Prior Lake, Minnesota 55372