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.� pRIOCITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
(93 . 4
1.71
1.PFile PERMIT NO. 1 (,�`'j' //
MINNESD�P G 2.Green City 0
3.Yellow Applicant
(Please type or print and sign at bottom)
\,, ADDRESS ,,/ ZONING(office use)
A ,.CDS Z i�'7,/?/7f4/ A ,/ ,1 ID
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID " D'3 . V t('
Ci
)(
OWNER 9:4—.4— :2/40—, Ye-
(Name) /`7'/771 (Phone)
(Address) /✓!ra-cz r� .7117/)/t/.1 //
(Na e�cANTj/G��� ) � / - 725 - 7. 1i
\' G-? i��N Phone
l� MmDr7 !/Z. S'y1I
(Address) /,...‘15.-/�r Z��—���
(Contact Person) G��i" / ' /h (Phone)
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APPLICANT SIGNATU' ' �- DATE 6Il 7r‘-���
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTIONzi REPLACEMENT CI ALTERATIONS
FURNACE MAKE ASND MODEL �/• S1'' FUEL , '.4* C.---ns
FLUE SIZE RETURN OPENINGS ...4-7 ' ),2-, INPUT /e' 6MOUTPUT IV -7--,
x TYPEOF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
a.Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
0 Gravity ❑Hot Water into Required Side Yard Setbacks.
❑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 $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $ 4C1.SO
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5 2--1. 47
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372