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May 17 11 08:29a MICHAEL GORMLEY 651- 628 -4924 p.1
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A CITY OF PRIOR LAKE Date Reed
HEATING /AIR CONDITIONING/.FIREPLACE PERMIT 5 zO, //
4j0,1ves00 I. o City `1 PERMIT NO.
J. Yellow Ap .T 1 / / . T //L/
o I
(Please type oe pint and signet bottom) - -- -.
•
ADDRESS ZONING (otsce en)
1 ( 2 % ).- ap. Rr o Ae_ s e e
• LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) k3 1 l (_ 14 Re i/\ (Phone) I' < i - 4 o -1.27
(Address) 17' a,0` - 4y, s S f . Lille /C.-.C.„ VII Y) 5x'3 7 a
am)ANT (7 4. N I.Q.ak-i . A i & (mono G - - 6 : ? -/ z/
(Address) 5.,S 11 (K4 (Sf� l6 (j ars 5ke�!��d) i C. 4 Cr2 4
(Contact Person) O / %. ( ) -
4 117 /
APPLICANT SIGNATURE I i rte DATE �I
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION !` ' LACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL .1 iA ( ' v'\ *11lK /t , 6 « -. • in • U aair FUEL A) (4u R.. (9-'t S
FLUE SIZE ' ?V C RETURN OPENINGS INPUT 60 O cap MibUTFUT S V , 000
TYPE OF SYSTEM ffi=ATING OR POWER PLANT PLEASE NOTE: Air Conditioner
ZWann Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
Doravity ❑ Hot water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
0Air Conditioning ❑ Special Devices Cantilevers a the Outside of Buildings
[Vent. System ❑OtherDevicea
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% of job croft Residential. Gas Fireplace $49.50
549.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64..50 Residential. AC Only 549.50
Estimated Cost S 2 b CO. (. Building Permit The Minnesota Statues ti 326(3.148
HEATING PERMIT FEE S 4
"SURCHARGE" has been changed for one
� year effective
STATE SURCHARGE S 5f July 1.2010. aalil .Iunc,30.2011.
TOTAL PERMIT FEE S fillainfa The Waimea surchery: ror a "fixed fee" permit
Mince Use Only) is SS bet tiaaia/.Inly 1.2010
This Application Becomes Your Building Permit When Approved Paid 5/4 j No. (a Zy G ?
c �
Banana Official Date �� `� , . l /
Banana .
24 door notice for alt inspections (952) 447 -9950, fa: (952) 4474245
4646 Dakota Street S.Y., Prior Lake, Minnesota 55372