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i "1° CITY OF PRIOR LAKE `-�'s Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT` db "
MI 3i51,9 4 f
1.Pink File
Ort4 -72. 1
NNEsoTPERMIT NO. 14,
2.Green City i r
3.Yellow Applicant i
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
t-1 256 Tiro -- Nye-. 3E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER t ^
(Name) v t 1 V\ l
(Phone) Y J 2 — 2 sq "30 8S--
(Address) ` 1 2c-- brov, to Avc s
APPLICANT I ,� -1157-4/
(Name) 0 L. I t I n.'/�■ ` Lir (Phone) (S' 7 7
(Address) '
' ''
(Contact Person) , _ , (
_ ,�, , ` Phone) CO,S ► ^ L3-7 -44J17
APPLICANT SIGNATURE 4---1,------ DATE 1 13) 1 + `i
4
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION (REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL ON 1+o-tu.-- -6 n R'j55(j 7 o 3 FUEL (- (aiC
FLUE SIZE RETURN OPENINGS INPUT 10iv03UTPUT (,g ( ',$9(D
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
M Mechanical 0 Radiation Fireplaces with Box Additions or
it Conditioning -� 0 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 $ ST)
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 54. J
This Application Becomes Your Building Permit When Approved Paid 611 C R Pt No!61/9 ?.
Building Official Date Date Gr, ,(a i` B 1� /
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372