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AL. 26. ')U1',) 9:22AM METRO AIR 952- 447 - 8126 NO.617 t P. 2
CITY OF PRIOR LAKE L7„..
114-,:, Rt A.TINGlAIIt CONDITIONING/FIREPLACE PERMIT
�. r,� c1 PERMIT NO, c� ° k
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440.$00 a. Ysfow p k nl
wn type or print and sign et 11 oltom _ ZONING office use)
4 — I - D, '7 0 r■\(..\14 c.1 Q a CA .- 6 Q..
ADDRESS
LEGAL DESCRIPTION (office use only)
PID
LOT BLOCK ADDITION
OWNER -- Z" f ` ! 43110110 `cJ'"
(Nam
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-
(Address) "� _ - -
' APPLICANT \ b 4; , L (Phone) 1 \-\ I �' a1,
(Name) S �
r( (Zip
(Address) ! V L (Address) 1 (C4tY) (2i ade)
cA L, L t (-■ �Z ' _ done) 1 -� ...3
(Contact Petson) , `
APPLICANT SIGNATURE ` A _ ,,,,, ....\_A, DATE
APPLICANT PLEASE COMPLETE BELOW
E1NEW CONSTRUCTION W, REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL
\. c-■ S r VS (- I N's % `1 ' ,9 PURL 3 C it
FLUE SIZE `) \I RETuRrt OPENINGS INPUT +� V OUTPUT L,, u es")
'1?E OF SYSTuIVI HEATING O]t POWER PLANT .
PLEASE NOTE Air Conditioner
I NZVxrm Air P1anta ❑ Stolen Units and Fireplaces Cannot Encroach
['Gravity ' ❑ Hot Water into Required Side Yard Setbacks,
Dill Mechanical 0 Radiation pirepiaee$ with Box Additions or Conditioning . Sys em 0 Spheral Devices , - Cantilevers to the Outside of Buildings
pV ctrl. System [� Other Devices - Require a he
Permit. u
1?1REPLACB MAKE AND MODEL T r
FEE SCHEDULE $49.50
industrial, Conuuereial & Multi-Family 1% of job cost Residential, Gas Fireplace
$49.50 minimum
Residential, Heating & A/C (Now Construction) $149,50 Residential, Additions & Alterations $49.50
Residential, Heating Only (Now Constructions) $64,51)
Residential, AC Only $49.50
"
Estimated Cost $ \)C Sa I Building Permit #
HEATING PERM ; FEE $ c .
U
STATE SURCH GE $
TOTAL PERMIT BE $ s
(Office Use Onl)) •"
( �O ���
This Application Becomes Your Building Permit When A$� Paid ✓ � -, Reci No.
Date - 7 / (o • t c)
13y
B attainQ °Metal O ath —
24 �-
24 hour notice for an inspections (952) 447 -9654, fare (952) 4474245
4646 Dakota Stree(..S.E•, Prior Lake, Minnesota 55372