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o � FR/0 CITY OF PRIOR LAKE CY Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT 9 He -
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4'INNESO1- t. Pink File PERMIT NO.73 /0/1
2. Green City
. 3. Yellow Applicant
- - - • - or print and sign at bottom)
ADDRESS,) ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O me R k2r. Netrtc Q,C ` a (Phone) fS `/ 7/5--
(Address)
A�CANT
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A _ . _ � a - .YLG ' u.n 05 4. 7 4 / 7 '8//0
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-�� DATE l6 / 3
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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
❑ Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
❑ Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
Air Conditioning Fireplaces with Box Additions or
g ❑ Special Devices Cantilevers to the Outside of Buildings
❑ Vent. System ❑ Other Devices
FIREPLACE MAKE AND MODEL Require a Building Permit.
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
Cost $ Building Permit#
HEATING PERMIT FEE $ 4' Sb
STATE SURCHARGE $ . p p
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid
,S — g 5 , --L) Recei o. 7(/O7_,
Building Official Date Date Q /(,, (� B Q
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372