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CITY OF PRIOR LAKE Date Recd HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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2' P File PERMIT NO. /' tl
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, t.;�rt'.. ‘i 3. Yellow Ci ' ✓ w Applicant
(Please type or print and sign at bottom)
ADDRESS t U‘-) 1 0 ` N ( \n 1 e f � ' P ` l 0(1 ZONING (office
I'1 �,►v Cj ll/l� �I+ use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �L� C` (Phone)
[ ]
(Address) 1 �2 > I. P' A " () O +"I�C�1�� ��''1 .
APPLICANT
(Name) (Phone)
HeARRF4 & Heim& TEEHNEK,eeIES, INC.
(Address) tabs FIRESIDE HEARTH 8t HOME
Lic. BCOS3.2060
270QAAIRVIEW AVENUE N (City) (Zip Code)
ROSEVILLE, MN 55113 � `yc - � (Phone) LO C1 G7 36 11 O
(Contact Person) 651.633.2561
APPLICANT SIGNATURE , A DATE _7440
• PPL I C •% l PLEASE COMPLETE BELOW
[NEW CONSTRUCTION - ' ❑ REPLACEMENT Q ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE:
Steam
❑Warm Air Plants ❑ Air Conditioner Units
['Gravity ❑ Hot Water
❑ Mechanical ❑ Radiation Cannot Encroach into
❑Air Conditioning ❑ Special Devices Required Side Yard
❑Vent. System ❑ Other Devices Setbacks
FIREPLACE MAKE AND MODEL ■ 1" 0 1" kL 0 /1//0 )
FEE SCHEDULE --1.; Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace 9.50 t{ `i _ L
$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 $
STATE SURCHARGE $ 5 0,(L
TOTAL PERMIT FEE $ J" %
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid r� -S0 Receipt ,
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Building Official Date Dat J (i ! 1/� /, /' 74 4i
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 /