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Air Conditioning Permit 13. 0793
w z 1§ \ § d e E■ u -16 � 2 w , § 5552 , > a■ &5 ■ « R §22© $ % . S u��0 . - ■ se.. © o � _ \U '''3 u.. ..,, 0 C4 0 0 d §§ a CO k 0 q Z ■ \ z . 0 E o . % 3 0 8 8 4 \\ F PI la t la 1 k \ o w § % \ � : 2 ® § k o a z� @ § u® §�U \ o o z § a� § ■ a � 00Z QQOOOO , 114 0 o . Z % % N ce a. \ }� § 2 10 o � �§ z 0§ J 2 % 5 1 Q < P ° # P. 0 z ^ § 0Z 2 « »� �§ 7 � 0 0 $ Z u) b b . �� \ � � 3 k t 1 V ' / & ° $ o u. u. is. ■ri:■ o 0U g o■ 2 o a 0000 0 LO 0 3 d 1 i p RIp CITY OF PRIOR LAKE Date Rec'd 1:-. •,` HEATING /AIR CONDITIONING /FIREPLACE PERMIT ti. �¢ irl d .�P 1. Pink Filr %A'NESO 2. linen cit PERMIT NO. J3 0 7 q3 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 5 Li gS ' StTho l D LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER \ * r 4 t 1 � i \ Z,] (Name) . l ' " I I �— (Phone) — 1 > o C7 f SN (Address) S9 "I S S1V't Tr( A.1 1 9n, O 1,04.4 APC, A Q� l / t,� V — ~ (NamPLIe) ANT N` 1 �n� J OB 1 Il�- 'rn��/(1 1 � l v� (Phone) q St- 7/ W i Address 12o W ' li�J t) &) � (Address) l rt- S S379 . (Address) (City) (Zip Code) (Contact Person) (, s ►� i I ; ' r (Phone) -1 a / u ' I1� s LAN V) APPLICANT SIGNATURE 9� DATE 1 ' ) "-• 1-3 APPLICANT PLE COMPLETE BELOW ❑NEW CONSTRUCTION ` REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL FUEL 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. ❑ Mechanical 0 Radiation Fireplaces with Box Additions or 1111Air Conditioning ❑ Special Devices ['Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi Family t % 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 $ 3. S Building Permit # The Minnesota Statutes ti 32613.148 HEATING PERMIT FEE $ 1t .,w "St. R(11 \RG has been chunked lift one year effective STATE SURCHARGE $ 5 t» 'SSA. July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit (Office Use Only) is 5,5, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid g j 5-6 Receipt No4 95 Date 7A By ),11-,.. Building Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372