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PR� CITY OF PRIOR LAKE C/ Date Rec'd
°° u � HEATING /AIR CONDITIONING /FIREPLACE PERMIT
1i'NEsd< \ 1. Pink He X O. {{ �
2. Green City PERMIT 1� 7z �� 1
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S7 s g r.od
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) IA # /A II a ' (Phone) 1. " ,I "- ..,
(Address) 541Y11.6,
APPLICANT
(Name) (Phone)
Appliance Connections Inc
(Address) qq qq pae Cr
�A�d�S n
s) (City) (Zip Code)
Shakopee, MN 55379
(Contact Person) �� , R (Phone) ,��
APPLICANT SIGNATU • a • a A 1 , ii / DATE — �:�•J eLd --
l• -
APPLICANT PLE SE COMPLETE BELOW
['NEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODELLUUQ - 0) -CRUEL
FLUE SIZE RETURN OPENI GS INPUT OUTPUT- D J ()On 6
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 ❑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 $ Z5130 --..---
5 Building Permit #
HEATING PERMIT FEE $ O
STATE SURCHARGE $ • 0.0 .54Er
TOTAL PERMIT FEE $ VI
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid , / Re • t No. ,p z 5 s—
Date `�
Building Official Date 3 . Li la--
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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