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4 r xto CITY OF PRIOR LAKE Date Rec'd
° HEATING /AIR CONDITIONING /FIREPLACE PERMIT
o
o .��. 1. Pink rice PERMIT NO
./0 2. Green City •/0 _ 00z/
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
N WA 6\A 6t(kCI 3U 1/4 - )
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) R_ r 1 . a.J A A (Phone) q S? - 1-9(r' l
(Address)
r� 4 4 \ i 1'VW c J/ w b
APPLICANT One Hour Heating & Cooling
(Name) 1904 Vermillion St. (Phone)
(Address) Hastings, MN 55033
(Address) (651) 437-4177 (City) (Zip Code)
(Contact Person) / einf-- / (Phone)
APPLICANT SIGNATURE L 1 v DAT /Z - 3 1 -0 )
APPLICANT PLEA E COMPLETE BELOW
['NEW CONSTRIACTION EPLACEMENT ALTERATIONS
FURNACE MAKE AND MODELt1'1\-C''�- c "�" 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.
LT echanical ❑ Radiation Fireplaces with Box Additions or
pv it s tinning ❑ Special Devices, Cantilevers to the Outside of Buildings
• Vent. t. Conditioning
System ❑ Other Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% of jab 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 549.50
IL 0
Estimated Cost $ '
Buil ding Permit #
HEATING PERMIT FEE $ ! • 5
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ,67;'• ea)
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ¢ Rec No. ,..5 ?
Date /, /�. / U
Buntline Official Date ,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372