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o� PRr CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT L e N- Z-'
U t•"
NNES
1. Pink File
2. Green City 1 1 PERMIT NO . ``Z�(
1
3. Yellow Applicant l
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
JL/t.93 II R'Q „ C
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �I� pb \1 b1/4,,..) , l , 3 QI1
(Phone)
(Address)
(Nam ICAN / Z__ ( Phone ) !s °y7 7 -�� 1 0
(Name) rid r C.. �L
/ , I- c ` �t`1 a L4(e Irl S&3 7
(Address) /`4H\�i � Pei �YJ � ess) �ro � � �� (City) (Zip Code)
(Contact Person) " rr.----N. I g��'
(Phone) 'T' Y ? 'e I ) 6
APPLICANT SIGNATURE / .. ii A%/ ., it . i s DATE 9 "2 1 I
APPLICANT PLEA "_ COMPLETE BELOW
❑NEW CONSTRUCTION (I PLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
G ravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
❑Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
EVent. System ❑ Other Devices 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 $ Ag Building Permit #
HEATING PERMIT FEE $ , --f c-t' c)
STATE SURCHARGE $ Soo :-5(+-
TOTAL PERMIT FEE $ S ut AO
(Office Use Only)
This plifatio co Your Building Permit When Approved Paid (., ► _ -v ii Receipt No. 6.2
2, - L L Date �
dine Official Date ^ � �� �, By
3cc
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372