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p Rl p CITY OF PRIOR LAKE Date Rec'd
° � ! e HEATING /AIR CONDITIONING /FIREPLACE PERMIT j 7ji , 10
H 300 V3304 r
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NVIYESO 21 . Pink n F ci city I �/
PERMIT NO X
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3. Yellow Applicant O t 0 0
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I L1/i L41 Sw
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` f7 -iti,4 ��
(Name) Z'€- ' •• �� (Ph one)[' Z- V5
(Address) tc, 2 /�j // Lie? S t 1 J
APPLICANT v,
(Name) Standard Heating & Air Conditioning (Phone)
130 Plymouth Avenue North
(Address) Minneapolis, MN 55411 -3445
fiia40 266 (City) (Zip Code)
(Contact Person) A � / f /�1 (Phone)
APPLICANT SIGNATURE � 'g
L L DATE fl
APPLICA PLE • SE COMPLETE BELOW
❑NEW CONSTR TION III ' EPLACEMENT ❑ ALTERATIONS
' /
FURNACE MAKE AND MODEL r`,L4 r/ , FUEL t--
—
FLUE SIZE RETURN EN-NGS INPUT it / ft° OUTPUT 207 ( 1 00
TYPE OF SYSTEM HEA _ ING 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 0 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 $ 'C. Building Permit #
HEATING PERMIT FEE $ ' 7 g+ 5
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 4 6 - 0 Rec. ip o. ? 0 p
BuildinH Official Date Dat Z l 0 B 1 0 ,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372