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4 ,Ri CITY OF PRIOR LAKE Date Rec'd
i ' HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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Ftlf AC.
j i i. ze File . / PERMIT NO 2 . 4-
NNBSO o LY '
Z. Cirz City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
H 111 S\1601/ PiOL \ .:k
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT
(Name) GEN Z -RYAN (Phone) 952-767-1847
(Address) 2200 HIGHWAY 13 W, BURNSVILLE, MN 55337
(Address) (City) (Zip Code)
(Contact Person) L I SA HERNAND Z (Phone) 952 - 76 6 7 -18 4 7
APPLICANT SIGNATURE . 4 nil 411. DATE Z/
APPLICANT PLEASE CO 1 PLE' E BELOW r
DNEW CONSTRUCTION ❑ REPLACE ' : 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
CI Gravity aHot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ 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
I WOO ,' ` `' i 1 g aS /(I' FEE SCHEDULE V i' ' 'r , r O-•■
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 4
The Minnesota Statutes * 32613.148
HEATING PERMIT FEE $g `56 "SURCHARGE" has been changed for one
year effective
STATE SURCHARGE $ 00 ". ,Jule 1, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ 561 SD The minimum surcharge for a "fixed fee" permit
(Office Use Only) is SIS beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid 5- ;7 Recei 'No. 65709
Date By
Baildina Official Date 5 - . /0
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372