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Heating Permit 13. 0576
3 ❑ O `I 0 00000 0 '0 0 > ZS_� v on n J 0 NT — T'n -n o N 0 > o M 0 0 m>c � C00 Z m m m b r ° 3 r m z : d - N - rTi r- n n co m N S zD Z Q N O -0 tIll t --I -i > Z 0 00 z - ro n N "'"I n z 0 z � • io O 2 -n 0) -� z O ,_ m D 0 v,-1 D • o O n z n • -n n z .-4 m m n x o A ti ig z 7J o 0 0000❑❑ 'T1 m m m m - ` 3rN *3 -I N o o �-�C n c -I n c '� y .. Z -0 k Sz W -o 0 N y C -0 0 Z Z x x— E 70 z 1. x • 0 j Z > CC z c a O • z n m r - v - o O m A 0 v = m 42 0 � c7?) m '❑❑❑❑❑ 1 vl ■ y Z z I0-11-nom vj i R. n z n � 73 02 , m R. 0 0 N mm 3G) , z t' 0 m 0"� -4 r 0 z z m ��P CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING/FIR PERMIT 0 '�r *N E s °S t 1. G ee F P ERMIT NO. . — 0 z. Green c aY 13 (U 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1 ZONING (office use) 33 29 aI r T N r- ..2. r P 2 LEGAL DESCRIPTION (office use only) LOT BLOCK / ADDITION 2 EL/,VWj� /C'/2. [�C TQ . L N& PID ,2b - 3 S 2 — 0 /C/ " 0 OWNER / (Name) ( A Qde- 1 p, (Phone) l 5) - /ILO (Address) 33'a 1 G 1 ` v. tA.; T . _ . APPLICANT (Name) f 2f 1 C ki -.y ,7.� (Phone) 6 a -568 - `1'a�. (Address) 0 19 1 r 1 -to 1 - / • G P/1 is ` (Address) (City) (Zip Code) (Contact Person) a SACtiv f �� (Phone) -0, SDg - TAXI APPLICANT SIGNATURE / S DATE 61/ 0 I / APPLICANT PLEASE COMPLETE BELOW [NEW CONSTRUCTION ❑ ! REPLACEMENT [ ALTERATIONS - / /� FURNACE MAKE AND MODEL t a t ikfL - NIA IN J - FUEL /i�7/'f . FLUE SIZE A v--/ f RETURN OPENINGS / OA INPUT ‘4 OUTPUT gig i TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner arm 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 [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 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 $ 030 S' ©a Building Permit # HEATING PERMIT FEE $ T"t . S® STATE SURCHARGE $ 5.00 TOTAL PERMIT FEE $ (Office Use Only This Applicn Beco 1 • our Building Per , it W 1 • ti �i ( , Receipt No. ,� � _J Date CV Q By Buildine Date C. 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Print Page 2 of 2 http: / /us -mg6. mail. yahoo. com /neo /launch ?.rand= Odnv51u4luji4 6/7/2013