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FRIOT CITY OF PRIOR LAKE Date Rec'd
9 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
cNNEscp-'1
g
2:Pink n ale PERMIT NO.
3.Yellow Applicant ��` '.. /
(Please type or print and sign at bottom)
ADDRESS C.oZONING Office use)
I 7 .9 � . ruf sl.J ' c,K. AVPirJu (1 e 2 ow
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) D LL.&n eisl O S' i m an (Phone) ao/a) 3 8'o- 11 9 y
(Address) /6,7e31 rustso ck A/eau e. o. Pr to r �c.,k J fh4) SS 37'
APPLICAN� / r d ('
(Name) GLA-/. /`fta.:-: r rIiRZPrii1'ct' Phone) fry4,j `/03 --///D
(Address) la q I n Jam- 4 L7& it.c,// SA41-/O a Mini 8-5-3-17._
(Address) (City (Zip Code)',
(Contact Person) Z O i1.E a QL C (Phone) CCl-s61—) I/03—/// D
APPLICANT SIGNATURE C f < / DATE 42 ' c0.2 —may
APPLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION /� [PLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL p / n P !" a SIS si lig'/c O(oO 6844 FUEL .� JG�
FLUE SIZE `� RETURN/OPENINGS INPUT 6 0 ooa OUTPUT O20- -
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner.
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks,
[Mechanical 0 Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices
['Vent.System 0 Other Devices Cantilevers to the Outside of Buildings
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 $49.50
•
Estimated Cost$ g g7 — Building Permit #
HEATING PERMIT FEE $ `Y9 5 D
STATE SURCHARGE $ .f8&
TOTAL PERMIT FEE $ —5— S 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt . )
Date By
Buildine Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 1