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04 rnro4• CITY OF PRIOR LAKE ]Date Rec'd
1.74.:,: .''''''1•4A HEATING/AIR CONDITIONING/FIREPLACE PERMIT �
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I1.rinkCit PERMIT NO /4:63
NNES�* 2.Qreen City '3.Yellow Applicant(Pase type or print and sign at bottom)
ADDRESS r / ) ZONING(office use)
, 309 1 L k -/a v e ri C ! AilkJ r 1 c; 6
LEGAL DESCRIPTION(office use only)
/ n/ ? UN
LOT 5—BLOCK I ADDITION/voe�� -�jGC 06 6_,_57,-;,.../,,,_ PID ....?5---- 37/- 19D5 L
OWNER /- 1
(Name) 7 r �e I) i� (Phone) v d 70 � c? .
(Address) / Lal e. t-1 a V e''-, r 7 1 V A
APPLICAN i
(Name) r IT✓t - /�e. a -i-7'� c4 71 � (Phone) g�o) �/ S 777 7
(Address)S e �j11 Q J b ^ '� Ave f
(Contact Person) Cfel t-e( /i (Phone)
APPLICANT SIGNATURE ill a, 0DATE g id-s— /
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS n
FURNACE MAKE AND MODELS a_VA T ci V 7 M '4 CO O O 6 C) FUEL L l a S
FLUE SIZE RETURN OPENINGS INPUT aO, 000 OUTPUT 7 5, -i aQ
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0Steam Units and Fireplaces Cannot Encroach
Gravity ❑Hot Water
Mechanical into Required Side Yard Setback.
❑Radiation Fireplaces with Box Additions or
Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑Vent. System CI Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial,Commercial&Multi Family I%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 Pertnit#
HEATING PERMIT FEE $ Lf 9 ,SD
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ C(/ . .
This Application Becomes Your Building Permit When Approvedgktd. 0 ,Receipt No
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Building Official Date Date R..3. \4 By D-
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24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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