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VRI CITY OF PRIOR LAKE Date Recd
° , :11;4:.`72., IIEATING /AIR CONDITIONING /FIREPLACE PERMIT
0,,,, e,, o rs 1. i File PERMIT NO. /A ^ 0`f'!
�IV)?ti ii Crrrn City
. Wow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (awe use)
59(8 c- tcuctd l Crcue SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) I nla.4. Ll LLt h- f ( Phone) 9 S -- LI LI "- co ao
(Address) 5° LQb Rai/lc/eau Ct de SE , Ph oe Lo M &I 55 3l a
APPLIC
•
(Name) R ANT
e-S i d-exv 10 - • + k( 1- (Phone) co 1 D - - 73- Li - Ihq 9
(Address) I - v' ' . -e p 1 s • 5 0 - 7
(Address) (City) (Zip Code)
(Contact Person) ... ' 7. (Phone) (-12 av a L I — 1F3ci 9 APPLICANT SIGNATURE / . /
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION IqREPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL Ot.r V l'<_.1/ 5S M v C.OSO FUEL PV , C°) a_5
FLUE SIZE _ RETURN OPENINGS INPUT 8o ) 00-0 -o-0 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 ['Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
[Went. System ❑ Other Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL _ _
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace 549.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations S49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only S49.50
Estimated Cost $ 15 • U Building Permit II
HEATING PERMIT FEE $ q 9 , S°
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 50 Ci
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 50 D O Recei No. .rJ 73 0
Date / LL . /iv B /
Bulldine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372