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4 ?Rio CITY OF PRIOR LAKE Date Rec'd
° = ' ' P HEATING /AIR CONDITIONING/FIREPLACE PERMIT
4�1Mvsso'.r I. Pink Pik PERMIT NO
2. Cmen city '3 - /
3. Yellow Applicant , ? c'`°
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 53( 11 S -`,sL PO,'rf 2-ei SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER •
(Name) J 0k r./J W 11 sic; (Phone) e(Z - 3 - 52 ' (o
(Address) t s b S c P° ,y,-\-- 21 SE .
APPLICANKIine Corp.
(Name)._ DBA: Practical Systems (Phone) •
(Address) _ 4342B Shady Oak Road •
Hopkins, MN 55343 (City) (Zip Code)
952 - 933 -1868 f�
(Contact Pers. , Tot�(1 T ^^'S (Phone) ° !5 Z - 9 — 1869
APPLICANT SIGNATURE 1T CA )1 ct. DATE — 7 — 1 Z -- 2- ( 3 0
APPLICANT PLEASE 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.
jaMechanical ❑ Radiation
❑Air Conditioning El Special Devices Fireplaces with Box Additions or
DVent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL Z -- Koay •)--- ircp(a(AP
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
Estimated Cost $ Z, c,.) 0 Building Permit #
The Minnesota Statutes § 32613.148
HEATING PERMIT FEE $ [.�ei, �
"SURCHARGE" has been changed for one
year effective
STATE SURCHARGE $ .500 July 1, 2010. until June 30.201 I.
TOTAL PERMIT FEE $ f-j 4_ 56fhe minimum surcharge for a "fixed feel' permit
( Office Use Only)
is as beginning July 1. 2010
This A� c ion Becomes our Building Per t Whe ■ Approved Paid � Receipt No. q ��
d_ _ Date By t
lu dine Offic>a late 1 /2- '
24 hour notice for all inspections (952) 447 - 9850, 1'a (952) 447 2
4646 Dakota Street S.E., Prior Lake, Minneso a