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i r RIO CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT �aa 1,3 x 0' J,
"c.-). hi
jvNESe-
. Pink reen File J
PERMIT NO. /3 2 G C i
3. Yellow Applicant / r
(Please type or print and sign at bottom)
ADDRESS p k s ZONING (office use)
B
I55(a I rags l ct . �'1. kW X 2 Sh
LEGAL DESCRIPTION (office use only) /'
LOT) /- BLOCK f ADDITION( ,t/G)4e 3A1 /A',x p PID 45:367- 05-0
OWNER
(Name) n I L 1 7( ) (Phone)
(Address) ) 5 5 6 1 - IYW k.. 'i d . Lin M
APPLICAA T 1 , /
(Name) U -( f 4/1Air t�C� 1 1') (Phone) q 5 /7 g �/ - / OTh
(Address) 4 / V (t/ Uk(.t . #31 o / l'I DI k 7q.1 ijkLIS 55 12-40
(Address) (City) (Zip Code)
(Contact Person) MI6 L 4. I .. . (Phone)
APPLICANT SIGNAT ■
FigiM�. �� /1 DATE 3 /
APP /CANT PLEA E 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 ❑ Radiation
ir Condition
A ng g ❑ Special Devices
0 Devices Fireplaces with Box Additions or
ent. System 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
The Minnesota Statutes § 326B.148 Cost $ 41,50 Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, HEATING PERMIT FEE $ 4g, so
The minimum surcharge for a STATE SURCHARGE $ .50
"fix i1 fee" permit is $5.00 TOTAL PERMIT FEE $ tin. (1O
This Applic tion ' • co , es Your Building Permit When Approved A, . t i .. , c0 Receipt No. (� �/
(�
530 , 13 By
1 5--k ate °l (J i
f�
Building 0 i Date g .��/
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372