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rRio C. CITY OF PRIOR LAKE ,
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Date Rec d
e HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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'It &ESCi °' 1. Pink Pile
Z- cn. city PERMIT NO. ( t0
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' (Please type or print and sign at bottom) 3. ello�r Applicant
ADDRESS ZONING (office use)
5:235 g- Ofrk Pik %
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ZS . 4- l 0 341.0
(Naame J 1 ! C I f J (Phone) (�pZ ^ `, jam rr 3
(Address) a j - 64 1 Q a! ' Del'ice" f . APPLICANT e
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(Name) 1 i .'I 1 i • (Phone J V ' s'
(Address) 4,, ,. ,1 E. • __Y32,__
Address) r
1 (Zip Code)
(Contact Person) IA i 1C F /�. ( City
(Phone)
APPLICANT SIGNATURE , .'t _'i 1 Ii ► DATE -1/
' PLICANT PLE1. E COMPLETE BELOW ,
:NEW CONSTRUCTION %REPLACEMENT : ALTERATIONS
FURNACE MAKE AND MODEL. FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT L
:Warm Air Plants Stems PLEASE NOTE: Mr Conditioner
:Gravity ❑ Hat Water Units and Fireplaces Cannot Encroach
Mechanical into Required Side Yard Setbacks.
❑ Radiation
Air Conditioning 0 Special Devices Fireplaces with Bog Additions or
Vent. System [] 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
to
Estimated Cost $ 03 Building Permit #
o The Minnesota Statutes § 326E3.148
HEATING PERMIT FEE $ l s 5 "St;RC:1 IARG has been changed for one
year effective
STATE SURCHARGE $
• Q. July 1 2!110, Until June 30, 2011.
TOTAL PERMIT FEE S The minimum . urcharge for a "tiled fee" permit
(Office Use Only) is. tre;;inning.tiny1.2010
This Application Becomes Your Building Permit When Approved Paid S ,s 0 17 ipt Na. t 4 _ 4 _,
Date RIMINI Building Official Date ,, � 1 '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245 Ill
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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