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VRlp CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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llvNESO�P I. Pink File
2. Green ee City 43 6 7 / 2 ,
2 . Yellow Applicant PERMIT NO .
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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1 i V3 ` pal -ail i.,) D r 5 .E._
LEGAL DESCRIPTION (office use only)
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LOT BLOCK .ADDITION PID
OWNER j 1 f a �j
(Name) V `Qf j o TO- -e -gr (Phone) � d i qi ,5o �/
(Address) C 66/04.1. ,-
APPLICANT
(Name) : • V. HEATING' & AIR INC. (Phone)
5102 WEST BROADWAY
(Address) CRYSTAL, AL, t N 55429
(Address) 763- 535 -2000 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
ENEW CONSTRUCTION ❑ ALTERATIONS
FURNACE MAKE AND MODEL Lt Vt✓I a- ?/REPLACEMENT
to utio 1 Qxtl 3( e.i FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
NI Gravity ❑ Hot Water
❑ hanical ❑Radiation into Required Side Yard Setbacks.
it Conditioning 0 Special Devices Fireplaces with Box Additions or
[Went. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL •
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% 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 in Residential, AC Only $49.50
Estimated Cost $ U`" . Building Permit #
The Minnesota Statutes § 32.613.148
. HEATING PERMIT FEE $ q9, 5o "SURCHARGE" has been changed for one
year effective
STATE SURCHARGE $ ,IP July 1, 2010. until June 30, 2011.
TOTAL PERMIT FEE 5 �r , /■ The minimum surcharge for a "fixed fee" permit
(Office Use Only) is .5, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid 1�� 4---6 Receipt No. 93 9 , f
Date /� / By . 9 . A„,,,..
Buildine Official Date I /l
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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