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oi PRIc, CITY OF PRIOR LAKE Date Rec'd
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HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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INNESO�t' 1. Pink File PERMIT NO.
2. Green City /3 — / L /D
3. Yellow Applicant / ]'
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/5 63 ( re.vvvoy-t -\-- Ikv —
LEGAL DESCRIPTION (office use only)
LOT 00g- BLOCK 006 ADDITION 'Ts la+n i Vim) s 4 kidn. PID , 5.25 o2O ,2 Y0
OWNER �' ' / '`,/
(Name) S trj G r1 Kk° Y1CtL ur" (Phone) 9s Yy 2- 2`0S6-3
(Address) I'3( f-Y'eri'v )1--- Ave Prior L e_ ItilIV 55372
APPLICANT A
(Name) l--en er P o 4 Clete-1cl ( Phone) "7103 -7FS
(Address)3 e-t° h 8/ d t7AJ 16 d k Edls 7iTiu `J 33
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(Contact Person) 36 A h a. L 16. / (Phone) 710 3 - 775 'S4/6V
APPLICANT SIGNATURE i�� , , .1 / /� DATE /2467/3
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APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION OtEPLACEMENT ❑ ALTERATIONS /'
FURNACE MAKE AND MODEL Carrier S$C! V ink Oq Q - I -- i t FUEL N 4 .S
FLUE SIZE RETURN OPENINGS INPUT 940co OUTPUT 7.J,o 2
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑ Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑ ravity ❑ Hot Water into Required Side Yard Setbacks.
echanical ❑ Radiation Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
❑ Vent. 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
Cost $ Building Permit#
HEATING PERMIT FEE $ 44• co
STATE SURCHARGE $ 5. 00
TOTAL PERMIT FEE $ 5 9 , s
This Application Becomes Your Building Permit When Approved Paid Szi SO Receipt No. 7
Building Official Date Date / `/.J 1/3 By 7i.,..0
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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