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y HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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�j 1. Pink File PERM 1 IT NO. 1 J (F�
/A'NE5 2. Green City I
3_ Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRESS / f Z ((office use)
e rat h (.) 004 ei f GI€ /V, 6-' 1S�/
LEGAL DESCRIPTION (office use only)
LOT BLOCK. ADDITION PID Zdc - (B5' _ -
OWNER /
(Name) Eta' r k Eas 7``x/7 (Phone) Ze Io? - 20 8 -- 7SKO
(Address) - Gc a i n t.J2po c( C'cr, (e 4 E J PC'r‘o r Z c ke hod 557..37
APPLIC�T
(Name) (.c c,/, 47 h' e z i'g rd//Z lerd:c es c (Phone) e 195 ,A) '' -- // / 1
(Address)_ /. 9 di i/ei Lou .<, ?e d 1 ,, „VAa 1( ',►ibP MA) 5`37'9
(Contact Person) '` e - Z--a.- c_ (Phone) 9,5 4'03-7/ / Z,
APPLICANT SIGNATURE II!/_ / DATE c) A" -/y
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL 191)p 46 // ede r �S4J —Co FUEL Via. u
FLUE SIZE f RETURN OPENINGS INPUT 60 000 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
D9ravity ❑Hot Water into Required Side Yard Setbacks.
io Mechanical ❑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 $ 9 C ID • 0 - D Building Permit#
HEATING PERMIT FEE $ 4 / 9, Sz'
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ _5".3‹.3
This Application Becomes Your Building Permit When Approved Paid "I 5 - 0 Receipt Date No.40 /7„)
Building Official Date i) J , By / lU
L(4)
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372