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rR10 CITY OF PRIOR LAKE Date Rec'd
G HEATING /AIR CONDITIONING /FIREPLACE PERMIT ( .C. 05/
1. Fink Fil
2 . G Ci PERMIT NO. ®$ d3 7
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14 0 1 McY u&a Rd, U)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( OName) 1 O.d 3 VI
(Phone 5) 4/4-s-4(040
(Address) (40? 1-t eR
APPLIC . +T 1
(Name) I. I ' r• f� 'hone05 0 54, an
1
(Address) ✓ .4 1 . £ AS L E al i - —A...!
(Address) (City) (Zip Code)
(Contact Person) 1 .. it _ 1 (Phone) Q12. 4' . (p 12- �� � �� - --yy
APPLICANT SIGNAT • �� / DATE I. �! C.tJ�J
APPLICANT PLEASE COMPLETE BELOW
itt ['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
['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 $ 11 SD
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ‘50 • 0 0
(Office Use Only)
liph
is Application Becomes Your Building Permit When Approved Paid L;0 Receip o.� i1
Date 0 B
Buildine Official Date `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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