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1'RI CITY OF PRIOR LAKE I 54 , 50 , � te Rec'd
O
i-4,,e ` HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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11'NES0� 2 1. Pink G r een File C ity 1 1�
PERMIT NO. /1 9
.
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
f( St. Ave, 8.6.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER VW Id S (Phone) oeg -213 I
(Address) 1 000q a pc He &G.-.
•
(Name CANT o hp ft OUf' (Phone) @JN
(Address) 1804 Mimi 11 10 &M et t mn 556
(Address) (City) / �- / (Zip Code)
(Contact Person) 1 a - 1 I (Phone) bS 1 Ell
APPLICANT SIGNATURE k A / DATE _$ 1
I
APPLICANT PLEA, . COMPLETE BELOW
❑NEW CONSTRUCCTIIOON REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL 61k�"w FUEL
FLUE SIZE RETURN OPENINGS INPUT ,D, 000 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
ravity ❑Hot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation
Air Conditioning
111 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
Pcf ngtPrl Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one HEATING PERMIT FEE $
year effective STATE SURCHARGE $ .50
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $
The minimum surcharge for a "fixed fee" permit
is S5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid 5 Recei o. 6 . 4__/¢.6
Date q �� 1 I By
Building Official Date ! •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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