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C-1' r Rio ,. CITY OF PRIOR LAKE Date Rec'd
o l' HEATING /AIR CONDITIONING /FIREPLACE PERMIT
v
. ,..... OVA 2. 1. PinkGreen Fil i
C ty L/
PERMIT NO (1 ( Q
3. Ye Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
i CP E * nK;n
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID -
l , 2 •'
OWNER 6)1"'" — 1 1 A - , _ q
(Name) I) i nrl I e, C A (Phone)
(Address) 434 (_ kCS ∎ ae. -16\1, 3. , Ll "R: S43
(Name) T dip q 3i - #31 - '7�
(Name) � Ps` ��- �.�1 �L 1 (Phone) `TJ
(Address) ( k3 - 14G Jh ' '- iOl p a ' , \iac Fe a -. 1 e � -4--
(Address) (City) II (Zip Code)
(Contact Person) T (Phone) q� — ` 1 '3 1 -dqq
APPLICANT SIGNATU G` d DATE (
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION .REPLACEMENT El ALTERATIONS .
FURNACE MAKE AND MODEL CL. PlE'51 — O Lo E- rnftES FUEL h r`
// u
FLUE SIZE 'O RETURN OPENINGS INPUT (D �-. OUTPUT ao , %
• TYPE OF SYSTEM HEATING OR POWER PLANT J
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
r • Gravity ❑ Hot Water
M , echanical into Required Side Yard Setbacks. �
❑Radiation Fireplaces with Box Additions or
• Air Conditioning ❑ Special Devices
❑Vent. System 0 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 $ ��� Building Permit # The Minnesota Statutes § 3268.148
,,n "SURCHARGE" has been changed for one
HEATING PERMIT FEE $"T * -73 year effective
STATE SURCHARGE $ r •'3'0 July 1, 20ii3, until June 30, 2011.
TOTAL PERMIT FEE - $ 1a The minimum surcharge for a "fixed fee" permit
(Office Use Only) — is $S, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid , Rec ' t No. 6 Z iSZ
Building Official Date Date / � / / B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372