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o� r CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT tri
Aik 1. Pink File PERMIT NO.
f/NNESO�,' 2. Green City
3. Yellow Applicant �y ��
Wease type or print and sign at bottom)
ADDRESS ZONING (office use)
3/4 S en' N 9 l4_1(e. Rd- S. w
i
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Y\ ic 2.. \ ,e ti..XD cC k ((Phone)
.^I
(Address) c��.. ✓ L L---/
APPLICANT
(Name) . . _ - ..,c (Phone) et5 2 - 3>
(Address) . • t •
(Contact Person) S -o (Phone)
APPLICANT SIGNATU DATE —, 36 —f
III APPLICANT PLEASE COMPLETE BELOW
EW CONSTRUCTION X]REPLACEMENT ❑ ALTERATIONS
FURN y CE MAKE AND MODEL FUEL
FLUE SIZE " (Qtj( RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
El Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑ Gravity ❑Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
El 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 Construction) $64.50 Residential, AC Only $49.50
Cost $ Building Permit#
HEATING PERMIT FEE $ 41 5Z
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 4 ' Zi
*Application Becomes Your Building Permit When Approved Paid Receipt No.
Building Official Date Date --9t t 4 3 By �1 4
24 hour notice for all inspections (952) 447-9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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