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i VRI0, CITY OF PRIOR LAKE Date Rec'd
0 ,61,-,e;t0,4r MATING/AIR. CONDITIONING/FIREPLACE PERMIT
... S. 2, 1 13
0,1„.soo , Poll. Fttc
1 G co. PERMIT NO. /3 Q/(12
3. 'fallow Applicant
Please j or , 'at and ai 4. at bottom
ADDRESS ZONING (4s:else)
9. ? 7 6ra e A.E_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER-9 L,
(Name) 1 _,/ ... C.& //t1 SA (Phone) 112:-.2.2.6-.-__
(Address) ? 7"" 4 (Aiozzi c ill
.APPLIC
Col) 1A _.„ C_ (Phone)
f • a
(Address) . 7g 0 ( relit- ,LOT .s X Choi hAsufk
(Address) (City) (Zip Code)
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(Contact Person) eY f . Le i -1-0 1 13; 1 .111_t5_1 -
APPLICANT SIGNATURE AIM 4 ANIAAllila _
A O DATE 7' —
APPL AN ' (I .
‘,... COMPLETE BELOW
ONEW CONSTRUC ION 412 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT ___._ __ _ _
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Mr Conditioner
OWarm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
0Gravity 0 Hot Water into Required Side Yard Setbacks.
• 4 chanical 0 Radiation Fireplaces with Box Additions or
P :4 Air Conditioning 0 Special Devices
9111 mt. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL ,_,...... •
FEE SCHEDULE
industrial, Commercial & Multi-Family I% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $14930 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
-- b Estimated Cost $ ? 73(.0 / Building Permit #
Tite Minnesota Statutes § 32611.1
) ' "St IICI IARGE" has been changed Ihr one
HEATING PERMIT FEE $ year effective
STATE SURCHARGE $_____ Jul 1, 2010. until June 30. 2111!.
TOTAL PERMIT FEE $ 5 $o The minimum surchat ge for a "thed fee" permit
is SS beaming July 1.2010
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5g .c .-- 5 Re 1 ipt No. 6 qff
Date Date
nuiWine Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372