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ot PRI04, CITY OF PRIOR LAKE C.,..--' Date Rec'd
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT '. . /I/
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1.Pink File
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INNEso�P a.Green city PERMIT NO. l y&5.-
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
PI3 Li to LI i VAS \—.a NQ P'U 1:.
LEGAL DESCRIPTION (office use only) tt 11
LOT OCR BLOCK 00j ADDITION S -h49 �� P1' TheAZ lc PID 25 3 O-1 b oq O
OWNER � , �.,,I
(Name) 1 r `� una k (Phone) 9SaZ. ' g53` 1142
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(Address) 42Itib, \i,j'1 ‘c13 L NA Pr i or Lake./ 1) 5S37
APPLICANT
(Name) CENTERPOINT ENERGY (Phone) 763--785-•5404
(Address) 9320 EVERGREEN BL NW SUITE B COON RAPIDS. MN 55433
(Contact Person) JOANN Z KEN (Phone) 763-485--5404
APPLICANT SIGNATURE
.i/ _ i��,, Apii DATE //i , V
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 0 REPLACEMENT ''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
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
El Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
❑Vent. System XQther Devices Oxus ari i t Require a Building Permit.
FIREPLACE MAKE AND MODEL Ru.vx, WA 46 4..C.4rf, etas
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FEE SCHEDULE �r�[
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
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ 6j Qp, 00 Building Permit#
HEATING PERMIT FEE $ y9.5-0
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ d , "0
This Application Becomes Your Building Permit When Approvedl 9k g Receipt No.
to ii B /'� }•I
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Building Official Date . \ y t
24 hour notice for all inspections(952)447-9850
1
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372