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o f p Ro. CITY OF PRIOR LAKE Date Rec'd
H t - HEATING /AIR CONDITIONING /FIREPLACE PERMIT � , (3 . 13
si rNNESa`s t ' pin' File PERMIT NO
i
2. Green City ]� `�J o n.
3. Yellow Applicant �J .,....z
on
type or print and sign at bottom)
ADDRESS ZONING (office use)
1P2.13 904 -view ot• SE Pc./
LEGAL DESCRIPTION (office use only)
LOT BLOCK / ADDITION 60.4 �j t Ant K 1.4 . 3 /ejAllb N PIDa5 3 / - 01 9
OWNER D�,,M�/� r
(Name) (_,VA y CAV` V' lam' I I (Phone) G3 a -Lila -dx? / /q
7
(Address) \U a13 Pay k.v\ew UX? SE.
APPLICANT `\ \- n p� ] ` f
d
(Name) lKYY\ S I`t\ T \Y\0 k /�C' (Phone) cisa` LS"I -0005
(Address) • It _ sve, A. • _ 5337
(Address) (Ci y)) p( ((Zip Code)
W ilWire..../ q (Contact Person) (Phone) 18 - 1 t - OO b
APPLICANT SIGNATURE 3 u \kg, DATE 31 11
APPLICANT PLEA, E COMPLETE BELOW
[NEW CONSTRUCTION 0. REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL h1(Usa.Y mot Gb(D I FA bbb ON' fl FUEL '
FLUE SIZE RETURN OPENINGS INPUT IOU OUTPUT — 13,(19,(0
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
Air Conditioning ❑Special Devices Fireplaces with Box Additions or
❑Vent. System 111 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
Estimated Cost $ Building Permit #
� The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ i •..LJ "SURCHARGE" has been changed for one
STATE SURCHARGE $ year effective July 1, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ �L•J The minimum surcharge for a "fixed fee" permit
(Office Use Only) is S5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved s G Receipt No. 0 L i . c"
Building Official Date D . 1 . 1?_ B474/440 .,
cJ ��
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372