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VRIO CITY OF PRIOR LAKE Date Rec'd
AI 4 ri HEATING /AIR CONDITIONING /FIREPLACE PERMIT
, G Ci PERMIT NO /v e,2z,
�INNE$o�A . 2. Gran C1ty
3. Ydloc Applicant
(Please type or print and sign at bottom)
(� yV n I I ;
ADDRESS H i T, � t \ckcC\Jdij , 1 y ZONING (office use)
Il �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER K a„ N hone) / JO( "D `""' 1
(Address) \91 l 1M ' Me V Lrki - vim,
AP(NamePLIC) i ANT tA � ' 0. ' (Phone) C 1 L1 L1 L `I V lU 2
(Address) 1 lt0 i--- t...}6 cil S 'L SSJ')
(Address) (City) (Zip (Zip Code)
V' SO 1.t 1)0 (Phone) q L % i7'L1 4---"j (Contact Person _ _A. � _ � t
r DATE
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 5ZREPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL l QXI,(1 0( 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 ['Radiation Fireplaces with Box Additions or
NAir Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
['Vent. System ❑ Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
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 549.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid L----3 Rec i No. & (3 G d
Dateg / / v B
Building Official
Date •
r
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 1
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 '--