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o. PRIG CITY OF PRIOR LAKE (S Sa Date Ree'd
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT
�, 3-7q 013
(# . 30 . /
INNESO i.Pink File PERMIT NO.
2.Green City /
(Please type or print and sign at bottom) 3.Yellow Applicant I
ADDRESS
153�� 1 t VA�V ZONING(office use)
(Ss �-,'dllc_ rid �, 2
LEGAL DESCRIPTION(office use only)
LOT/l BLOCK" ADDITION `tie05, 4,),U / -$---/-,„%:;-0/0/A/ PID
R5--376... ,, 7.40
, ,,
OWNER
LqUditrli S
(Phone) Li 12 9b(Q 0(/71
(Address) )55a/ Lthi e.lc it-l.Ss P-J rice P-01
APPLIC, T
(Name) a I ..LL, z,r _4 • t • (Phone) LAS)-- (-/(-/ --)2" —Li) 1'
(Address) ♦ rAi �
(Contact Person) ,,,g4_,
(Phone) LK>i - C137 - 1-07-7
APPLICANT SIGNATURE 4_4( AIL( 1 DATE cei
@//51
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE:Air Conditioner
PLEASE Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water
❑Mechanicalinto Required Side Yard Setbacks.
DRadiation Fire I
Air Conditioning 0 Special Devices p aces with Box Additions or
Vent. System ❑Other Cantilevers to the Outside of Buildings
Devices g
FIREPLACE MAKE AND MODEL Require a Building Permit.
FEE SCHEDULE
Industrial, Commercial&Multi Family 1%of job cost Residential, Gas Fireplace $49.50
Residential,Heating&A/C $49.50 minimum
(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 $ 40 ,..es
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5-1.50
This Application Becomes Your Building Permit When Approved AI
Ifin Receipt No.
Building Official Date Date By l
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372