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04 PRI0 CITY OF PRIOR LAKE 'Date Rec'd A e HEATING /AIR CONDITIONING /FIREPLACE PERMIT 5.3 . /3
L ' . 7 )
1. Pink File
4/1 PERMIT NO. 3 6
NNESO 7, 2. Green City ��
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
7 7i- / / " //e-zri9 fr1/A-/ L
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25 epo. Ole, 0
OWNER
(Name) i f? 0\119Sfr7 P P4
/77S / c Mthte4T` (Phone)
(Address) -Si%
APPLICANT
(Name) Cj &/►/eSlS Phone) 44 .3 7C7 2
(Address) /50 / / Z (/' �
(Contact Person) /_... N KII a c (Phone
i I1.■_ /�►
APPLICAi -T 7 , tvi p.- .,ir - 410.------- ,....:,-„ �i�� DATE S. .3 _ (3
APPLI • NT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
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 FOfi, ❑Radiation Fireplaces with Box Additions or
L J Air Conditioning e.-€ El - Special Devices Cantilevers to the Outside of Buildings
e.-€ Vent. System /e-G'z, ❑ Other Devices Require a Building Permit.
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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
Cost $ Building Permit#
HEATING PERMIT FEE $ `7q' V
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ S r/ 5D
This Application Becomes Your Building Permit When Approved Paid fi r — _ Re t No. /_� {,� //
Date 3 `I (� G'
Building Official Date `
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372