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ii 36
C o1 PR °� CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
d rr NNESO ,�'"
12. . Pink File ry I PERMIT NO. / i Z Le, `
Gr
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS add , ,
ZONING (office use)
349LVI Fef? Pak" " / N 6 --- .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PrD
OWNER ' .11
qK/ 6 (Phone- 2 VW—V ';173
(Name) Q r I 17 hone (Address) 89/ ,4 j / 1 / / l ^ 1
APPLICANT
(Name) CENTFRPO FNFRGY (Phone) 763- 757 -6202
(Address) 9320 EVERGREEN BLVD NW SUITE B COON RAPI 55413
(Address) (City) (Zip Code)
(Contact Person) JOANN ZINKEN (Phone) 763- 757 -6202
APPLICANT SIGNATURE DATE
6
E
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ® RE PLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL e4/ • FUEL
FLUE SIZE RETURN OPENINGS INPUT y/D!Q?D OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
L'arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity . ❑ Hot Water into Required Side Yard Setbacks.
❑ echanical ❑ Radiation Fireplaces with Box Additions or
f ir Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings ,
:Went. System ❑ Other Devices 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 $ Z/ 5 M 1 CO u) Building Permit #
HEATING PERMIT FEE $ 0.,..56
STATE SURCHARGE $ 7 , 00
TOTAL PERMIT FEE $ 5 f ' . 3d
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid r28�1 Receipt No. j
Date / By e
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372