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Fireplace Permit 10. 0250
r _ 0 ■§\ . I § §« N g 3 55 z ` . k ■ ® § v. _v. � z < - « / % U �U| � , • ■ z § q N:30000\17 % 2 © re | ! u 0 0Q ' © z § A 2 Ili u. = 4 z — } } z Ili z ul k k% P 2 0 0 ° w W p 0 0 § § CC Jcc§LL ' 0 . t ■ g , a , 00 / i 0 o z e o a §■ ca a 2 § § w w § 000000 1111 §8 K Z a a .u. 1 ?" i x 2 S~ cc w� 0 <0 -� % x0 z 0 o S 5P 2 ' oP $ ■ 2 § z u - ■ a a ■ a.§ u) 2 zoz•cz W g u J % �� la CC On < =1 A § \ I. 0 / la Z 0 B z 22�2 p 0 « 0 a 000000 0 o 0 / PERMIT NO. jfj p R/0 CITY OF PRIOR LAKE 0 Date Rec'd HEATING /AIR CONDITIONING/FIREPLACE PERMIT 4t INNESD 2 . . P Gree ink n City, File O (JAI _ .V 3. Yellow Applicant , (Please type or print and sign at bottom) ADDRESS' 5 e ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER I A C \ �. (Phone) C 1 ✓)) - U1 - - 1 T.J" (Name) l'e�'1 it . Phone (Address) 1546 , i(1 1 4 APPLICANT W( V ; t , V ' 5J -1 1 - u 111 (Name) ( Address ) 1014........tvm'i , th , (Ph o Xf 1 5 , 55 3 `5 (Address) (City) "} Zip Code) (Contact Person) (Phone) J ' ( � APPLICANT SIGNATURE C v,`,,• �./ DATE ` I U APPLICANT PLESE COMPLETE BELOW ['NEW CO STRUCTION aREPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL '1'• i nrae■ nf1 Y � 1 5c1 04 e -- FUEL l NAT 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. ;11 Mechanical ❑ Radiation it Conditioning SS$ 14(4,4 ❑ Special Devices Fireplaces with Box Additions or ❑Vent. System 0 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 Estimated Cost $ Building Permit # HEATING PERMIT FEE $ 49. STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ S9 , It (Office Use Only) This Application Becomes Your Building Permit When Approved Paid �.- Receipt ■ Date By Building Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 , •