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r c?xt CITY OF PRIOR LAKE Date Rec'd
�� HEATING /AIR CONDITIONING/FIREPLACE PERMIT
� 1 M vsso"t r `• P"'' F''` PERMIT NO. -
3. Yellow Cit / / e ---
3. Ydlar Applicant �.J ea__
(Please type or print and sign at bottom)
ADDRESS ZONING (office ue)
/. / 9,G I - vE• / - 1 /,t,vks
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID -< - (S , 0/ f ,;
OWNER
(Name) (Phone) •
(Address) -
(Name) G 1 C. IT, I (C-- (Phone) QS a Nl 6 Z a- 7 •
(Address) / "y,' a- dL <.— GI- W j (... C 1 Aft i6 yh Il ,-J SS / .
(Address) / (City) (Zip Code)
(Contact Person ! / .^— (; / 1 t Ti.� , .. (Phone) .5?-4,-a-- ,9 v� — ( i t / ' 0 5 °�
APPLICANT SIGNATURE /
E _ DATE /1 ? — 13 "
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL A e_. F-/ a,5.., '(� AI l O� t � ? ,� FUEL 64
FLUE SIZE 41 it RETURN OPENINGS INPUT Sod ',1 n , OUTPUT ;,• ✓'
Vki
TYPE OF SYSTEM HEATING OR POWER PLANT
Warm Air Plants PLEASE NOTE: Air Conditioner
❑ St y' Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑ Special Devices
:Went. System El Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% of job coat 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 * 326E1.148
HEATING PERMIT FEE $ "SURCHARGE" has been changed for one
year effective
STATE SURCHARGE $ .50 July 1, 2010. until June 30. 2011.
TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit
(Office Use OMB) is beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid / , 1 - -- 0 R t No. / c f Z 0
Magellan Official Date � / �/` ,3 $ .
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 .