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O. PR/04. CITY OF PRIOR LAKE Date Rec'd
A HEATING/AIR CONDITIONING/FIREPLACE PERMIT $�'27. / 4_-
PERMIT
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2.Green City 4, , ?/3
3.Yellow Applicant i� l
(Please type or print and sign at bottom)
ADDRESS 6 �pyo f00.0/Al Sar, ZONING (office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLI
)CAS , �2.. �c(___' C-oi'S'v `r,‘-'mac t
S . (Phone) (9I S a)r-- -5 Z I
(Address). \ $ s. o-ze iL taA 6",
(Contact Person) S a\_.0----1 ,L—`� - (Phone) S
APPLICANT ICANT SIGNATUR,E I S . DATE /12 21 )-
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
El Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
❑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 $
STATE SURCHARGE $
TOTAL PERMIT FEE $ ,
This Application Becomes Your Building Permit When Approved Paid ter, i Roc" o. 72153
Building Official Date Date 71.77 Ali"
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372