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:.,./Ne7 HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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,A'NEs.,, 2. Gre 1. Pink File v PERMIT NO. oe . 0011
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
11126 5'un$e "lad 5W
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25. 1311, .007 3
OWN ''cI e I!' 1 A 1 fz1e (Phon( 52/1 17 3h5
(Address) ` 7I � l'� 5t f5 f 11 ?II SL
APPLICANT , jj ,, loo 9 /� / /
(Name)
APPLICANT /7 i L��� 602 /(4�i (Phone) q6.0? Q ' 1 ?6
(Address) /t3 NO oviS grlc, d AE Jfritho
��// (Address) (City) (Zip Code)
(Contact Person) G�it' Li //,/. (Phone) "/ y��>5 ��77 ,` " `''Q5 ,535
APPLICANT SIGNATURE AMR , DATE
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APPLICANT PLEAS; COMPLETE BELOW
['NEW CONSTRUCTION EPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL CowruvY 6g pm 8 OW FUEL on
FLUE SIZE RETURN OPENINGS INPUT (. b,D OUTPUT Sto 4W
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gfavity ['Hot Water into Required Side Yard Setbacks.
M)rftchanical ❑ Radiation
Air Conditioning ❑ Special Devices Fireplaces with Box 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 $39.50
$39.50 minimum
Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations $39.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $39.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ 3a . 6)
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 40. ob
lice U se Only)
his Application Becomes Your Building Permit When Approved Paid 46 O O Re t No. 6572,2, Date B 08 BuildinE Official Date . •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
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