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‘ , 6_,,. CITY OF PRIOR LAKE Date Rec'd
E HEATING /AIR CONDITIONING/FIREPLACE PERMIT /0
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I. Green City /�� / //, //
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3. Yellow Applicant !
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 /l 41° X i al . k s�
LEGAL DESCRIPTION (office use only)
LOT / BLOCK 1 / ADDITION J 4 4 v /Z°ci) PID pZ 452 VW- O
OWNER
(Name) ( 4u 4_,‘
s *5 /-1/ (Phone SF'V J7'o
(Address) 2 7 ' , 7 i s --- ' r ' (/ 'Ed - &L.
APPLICANT
(Name) CENTERPOINT FNFRGY (Phon 763- 757 -6202
(Address) 9320 EVERGREEN BLVD NW SUITE B COON RAP T JIS 55413
(Address) (City) (Zip Code)
(Contact Person) JOANN ZIN EN (Phone) 763 - 757 -6202
APPLICANT SIGNATURE e _ �_� .,. �� i(l ti DATE / /
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION ® REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity - ❑ Hot Water
❑ Mechanical into Required Side Yard Setbacks.
❑ Radiation Fireplaces with Box Additions or
[Air Conditioning ❑ Special Devices
[Went. 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 ■ 49.51
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ , 7 Sc . Building Permit #
i HEATING PERMIT FEE $ "r9 ti 6
STATE SURCHARGE $ .5. r✓ C-'
TOTAL PERMIT FEE $ CV 5
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid sy n Receipt No. 7 J //a
Building Official Date J // 3 By p,
ficial Date t7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372