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i‘pit CITY OF PRIOR LAKE Date Rec'd
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9 HEA /AIR CONDITIONING /FIREPLACE PERMIT
4,INNEso . 2 1 . YPie i le C ity PERMIT NO.
/ � +
3. Yellow F w Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 Lo l.t?�`- CittV ilk C t r c (
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
N �-
lr i I (Phone) 0 152- I Q✓ J' "J '3
(Address) 1 l.Y l ,t I Cf et i ci l ,i` rc. L c-
APPLICAN t , '' ,, r� �(
(Name) ' I." if y V _.r_! . >:
,.Z..��� I t
:. : ..�a.
• • ... • . ti y 'V J 13
,
• .. res� , _ I _ r 1 0 ' 4t.V Lei.. - nt 7„,---
• . (Address) (GS3t) (Zip Code)
(Contact Person) Yl (Phone) (I,S I - ` - 9 ' Y j
• APPLICANT SIGNATURE . A. .. 11 .JL DATE 2 /3
APPLI " ANT PLEASE COMPLETE BELOW
'
NEW CONSTRUCTION / REPLACEMENT ❑ ALTERATIONS L
FURNACE MAKE AND MODEL I�g, A I j j p C: „ , Ap FUEL 1 ((c5
FLUE SIZE RETURN OPENINGS INPUT il LC OUTPUT [i q
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water
.'Mechanical ❑ Radiation into Required Side Yard Setbacks.
DAir Conditioning El Special Devices Fireplaces with Box Additions or
❑Vent. System ['Other Devices Cantilevers to the Outside of Buildings
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 $49.50
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended ;ost $ Building Permit #
until June 30, 2013, V
The minimum surcharge for a HEATING PERMIT FEE $ I
"fixed fee" permit is $5.00 STATE SURCHARGE $ J .8
TOTAL PERMIT FEE $ 5 4 1 , SC)
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5z, S - ) Re• - ' .t No. 6 /1 G 9 I
Date3 1? t ,
Buildin¢ Official Date .
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372