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0•4 PRIp� CITY OF PRIOR LAKE C • Date Rec'd
x HEATING/AIR CONDITIONING/FIREPLACE PERMIT '7 / N-
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MI �P 1.Pink File PERMIT NO. }
NNEso 2.Green City r 461 3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
Not (cd arvvood court NE Fitc tare po D
LEGAL DESCRIPTION (office use only) 4..
LOT BLOC ADDITION s - ' 341- 4/,/,/
P 67OW
Ul vu e (Phone)`X52 '"C"1 J "i-5-t 3
(Address) ILt( 5( Ceda(1NoGd cif- : Rr La 557Z
(APP1e)CAN Y (' I5 N,4 c lcinl r i j L f`"tl J %JC'J
(Phon
(Address) ��� C o(�o4ni L rive S(iicOPee j37q
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(Contact Person) ULV )� Phone 3i
APPLICANT SIGNATURE . 1 11 1 rO DATE
4
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTIONREPLACEMENT ❑ALTERATIONSA 161
FURNACE MAKE AND MODEL �M�EL /V (�
FLUE SIZE RETURN OPENINGS INPUT /-0,DCX) OUTPUT J,'a-c)°
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.
L '' echanical ❑Radiation Fireplaces with Box Additions or
LA Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
El 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&AIC(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 $ ` t.SO
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved k '5-1,1.. ct Receipt No. ei i 11 3
Building Official Date \bate1 l I • B y 51
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 553724,04