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of PRIp� CITY OF PRIOR LAKE Date Rec'd
''' if'' t4C A HEATING /AIR CONDITIONING /FIREPLACE PERMIT 5 9. /3.
u :;T:,- „ rr , /C. , 6 - !/i/ f /3.. 2-70
�� � � '. Pink File PERMIT N .
NNESO 2. Green City
3. Yellow Applicant 3r7
(P1 sc type r print and sign at bottom)
� DDRESS, , e/� ZONING (office use)
Prri LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Z,S (q4 0
OWNER
(Name) (Phone)
(Address)
LICANT
(Z\Iame C NI 4 — 66 ctir e 4- (Phone ( 0'L . 6 . 07/
ddres 0 2 77 i ( I /J4 ( 5 c t , ( / e (4.2e 6 57- v vi I
�ntact Pers.* r0 4 h 1 r . v 5 ( (Phone)
PLICANT SIGNATU � � P ATE — - , C) 1
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑R PLACEMEN ❑ALTERATIONS
-FACE M /A154“... ,�rf . uit ,,,w`,,e/vs *. 4 Ft-r1 :o Z'T v
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 Cantilevers to the Outside of Buildings
❑ Vent. System ❑ Other Devices 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 Constru '•n) 64.50 / Residential, AC Only $49.50
Cost $ Building Permit#
HEATING PERMIT FEE $ 4 / ,_
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This • pry of i , ∎ omes Your Building Permi . h' n Approved Paid U Receipt No68 s
k 4*
r - By /
Builds ! . fficial 1 ate Date G
-- 24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372