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CITY OF PRIOR LAKE Date Rec'd
x HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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. PYvan ink Cit City PERMIT NO . 0 , /
2 O 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS /► ZONING (office use)
14 3 U ) I t4..e u4 5
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
,� yy�� 5111 i I(
(NameOWNER ) �� +� A l , jne) 1 1 1 — 267 1
(Address) 1 4 - NCO %4 . S7E_ eri it
APPLICANT One Hour Heating & Cooling
(Name) 1904 Vermillion St. (Phone)
(Address) Hastings, MN 55033
(Address) (651) 437 -4177 (City) (Zip Code)
(Contact Person) PGcnY�� / (Phone) �j
APPLICANT SIGNATURE L _ ' hit -, Altt.4 i DATE /' /�� /
APPLICANT PLE SE COMPLETE BELOW
❑NEW CONSTRUCTION tEPLACEMENT ❑ ALTERATIONS i i ,
FURNACE MAKE AND MODEL G m tic j s(nv FUEL /Y V
FLUE SIZE RETURN OPENINGS INPUT '10 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants El Steam PLEASE NOTE:
['Gravity ❑ Hot Water Air Conditioner Units
O Mechanical ❑ Radiation Cannot Encroach into
❑Air Conditioning ❑ Special Devices Required Side Yard
['Vent. System ❑ Other Devices Setbacks
i
FIREPLACE i. A KE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace • 1.51
$39.50 minimum
Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations $ 9 :r 0
Residential, Heating Only (New Construction) $64.50 `U Residential, AC Only . t
stimated Cost $ ��� - Building Permit #
HEATING PERMIT FEE $ q C. al
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ z 0 . SZ
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Rec a 'o. r./CZ--
Date By
Building Official Date 1 Z. Z/. (i 9 •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 III
16200 Eagle Creek Avenue, Prior Lake, MN 55372