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04 pRjO CITY OF PRIOR LAKE D Rec'
J U � c � HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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2. Gre 1. Pink en File PERMIT NO. /. . ,f
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
4a -166 S SL . 7?)SD
LEGAL DESCRIPTION (o ce use o)"
1 07 2—f- 7z v 1
LOT 3 BLOCK ADDITION 5 714) Oc2_6 PID 6' // 7 — 003-0
OWNER c_91e v J R0I2# h (Phone 3 Z (Ad dress) (0v8 - ��6 S � ( Pr o V ASS tR7
APPLICANT
(Name) CENTERPOINT ENFRGY (Phone) 763- 757 -6202
(Address) 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS 55413
(Address) (City) (Zip Code)
(Contact Person) JOANN ZINKEN (Phone) . — — • 1
APPLICANT SIGNATURE / �...4A % k,L.//t... _ ,L.//t... DATE _
II APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ® REPLACEMENT ❑ ALTERATIONS �D w /
FURNACE MAKE AND MODEL i -A ■ 2 ` • —
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
['Gravity ❑ Hot Water into Required Side Yard Setbacks.
p
Mechanical ['Radiation into
with Box Additions or
Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
ent. 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 0-49.50)
Estimated Cost VS Q.JO ) c 66 Building Permit # / 3 ' 0e3/7
HEATING PERMIT FEE $ Y9.5
STATE SURCHARGE $ t � . CC ' .50
TOTAL PERMIT FEE $...5 56
(Office Use Only)
This Application Becom • : Your Building Pe it hen Approved c lit • „ Receipt No. (0 Q5
3 at B y /
f - 47i I .5;4
Building • fici:l Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
. 4646 Dakota Street S.E., Prior Lake, Minnesota 55372