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rRro CITY OF PRIOR LAKE C.,/ Date Reedti° C HEATING/AIR CONDITIONING/FIREPLACE PERMIT
U ter!
�P 1.piny File PERMIT NO.
\ NNESOJ 2Gen City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
(5 Sgbni p353 Rob(( Lae
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Nam) O Ut, -INV PC4 10 0 (Phoneg52 '22 ✓-701-f
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(Address) 15geo 8i Horø I 55 For u✓�(APPLIJ
(Name)Cr15 Mas' cY coo! (Phone052 / 9T5
(Address)202S CQ( Li (7) ate 5V aikOf 14 37
(Contact Person) Liod (Phone)C2 L145 5a5
APPLICANT SIGNATURE Yla%it01Y DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION IEPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
0 Gravity 0 Hot Water into Required Side Yard Setbacks.
❑ echanical 0 Radiation Fireplaces with Box Additions or
IJ Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
❑Vent. System 0 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 $ A61,5)
STATE SURCHARGE $ 5 ��
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid This Receipt No. 7/J3 9'
Date /#2..2h,L t.)(1.2:„..,......---,-
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372