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Furnace & Air 13.1340
- o OX n OOCOOO Tv o a 20 § g sg 4 n n k x 73 7 . E � k C kkk z m z § o r o XX 3 r sz� p k r m m� m§ ;2 g co o � % t >§ -1 m 0 f § z k C- o ■ �© z z z ■ § tip §A 0 q � n z 0 . % m r - . x-I r 0 • rn k OO Oo § gIR m r ® *E-o X c ° 0 S 0S n ■ ■ ? A' ■ ■■ § m 0 0 § 2 M G 0 § § ■ ■� m % \ o z ©� r2 z o z$ m - 0 .. m 2 x o r -a . _ } m C k 0 . . li 0 . 000QOQ ! § m 1 - E § k § B ‘.■ ' r 1 o� r Rio �A CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING/FIREPLACE PERMIT dlj17YEsdlts 1. Pink Pile 3. Yellow Applicant PERMIT NO. A, . I 9 (Please type or print and sign at bottom) ADDRESS ZONING (office use) 34 ( S fl/ktiL; Tr . -` �NA/ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION P1D OWNER (N ame) GYl1�A -� (/� �l ��' (Phone) �O (1.- S O gy 0 `' b U (Address) S-e- • APPLICANT am en VV-6 (- -C. ' * �, C-- (Phone) 9 S Z' e S S - (Address) S F5 � C - ) �� `� l q ) Y�" t S EV I v& `' S S • (Add res6 (City) (Zip Code) (Contact Person) 4 i ' ' (AA:- C (Ph one) APPLICANT SIGNATURE r A _ a i DATE 11 1 S ( S APPLICANT PLE - SE COMPLETE BELOW ❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS 6 FURNACE MAKE AND MODEL t CtAVI `I 2S 91__C..) >6 o FUEL -S FLUE SIZE RETU OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Wann Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water into Required Side Yard Setbacks. IN Mechanical 0 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) S149.50 Residential, Additions & Alterations $49.50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Cost $ 9 0 1 1 • 00 Building Permit # The Minnesota Statutes § 326B.I48 q S � "SURCHAR has been changed Ibr one HEATING PERMIT FEE $ year effective STATE SURCHARGE $ .50 July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ 1 es• 00 The minimum surcharge for a "fixed fee" permit (Office Use Only) 5"l•S° Is $,f, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid 571 s Receipt No. y 7 fi/ Date 1 24/ By Building Official Date 1112 . • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372