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HEATING /AIR CONDITIONING /FIREPLACE PERMIT
1. Pink File PERMIT NO L�
41 .4Vmsd iP 2. Gran City 13_ / /
1 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
7133 Gatk ?ar Pc +h MAL - franc C4 ke., MIL 5
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER L /
(Name) M q f f ' IT i'l f iG.S (Phone) 805- S87 -17L
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Address _ U ^ •
APPLICANT —�—
(Name) 1 tnC..+E? . 3 � kej'SC n (Phone) q52- % }S - 129 4
(Address) 98 0 FAs-Ev ieUJ r i �� - S �a kn , ivi N_ 5537 9
(Contact Person) ` ciMet? .7i n kersin (Phone) S2— 9 /}S- ! Z q
APPLICANT SIGNATURE je , DATE / 2 -31- 1 3
APPLICANT PLEASE COMPLETE BELOW
El NEW CONSTRUCTION ❑ REPLACEMENT ]ALTERATIONS : :n5 /( R4+92
FURNACE MAKE AND MODEL FUEL NA fool L y a S
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
❑ Mechanical D Radiation Fireplaces with Box Additions or
❑ Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑ Vent. System D Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Colmnercial & 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 $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid ni r7i Receipt No. 7 4
Building Official Date Date iihI /k3 By
24 hour notice for all inspections (952) 447 - 9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372