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Rip CITY OF PRIOR LAKE Date Recd HEATING /AIR CONDITIONING /FIREPLACE PERMIT �. - - PERMIT NO NES
I. Pink rile . Green City I 2 -4J Yi
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3
3. Yellow Applicant [..� •�•�
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I4 g7 6 q - net- 0 c--
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT . ' 9 7( 2
(Name) �?., �ar i (Phone ` 1 —go
(Address) O2- k i Alm, FOU / . _ %
(Address) /� '1WC•„ (Zip Code)
(Contact Person) 1 �/ ► r `�i =. - - • 2 7 �.
APPLI t.:o ___._ ......' -. / ✓ i.�! i . = � DATE In 1 .---„-,,, -,,,,
__ ____ _ APPLICAN `' P • 1 u Dll B ii.:. _ 1 W
❑NEW CONSTRUCTION N I REPLACEMENT ['ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
2 TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
Warm Air Plants
❑ Steam Units and Fireplaces Cannot Encroach
Gravity ❑ Hot Water
•
El Mechanical into Required Side Yard Setbacks.
❑ Radiation
V it Conditioning ❑ Special Devices Fireplaces with Box Additions or
ent. 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
:ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid ,,�-� Receipt No. ` / ( �' j
G' 6 I
Dat B
Buildine Official Date . (a (2 y /j
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372