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01 PRION CITY OF PRIOR LAKE Date Rec'd
A HEATING/AIR CONDITIONING/FIREPLACE PERMIT /Q if 0-11-
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4/I 1.rink File
NNES �� 2.Green Ci PERMIT NO./ i��3e
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3.Yellow Applicant
(Please se or print and sign at bottom)
ZONING(office use)
16S51-1 t,� • t rherneess , SE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ZS 3 t 1E,0
OWNER r ' t , '� �e '
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Contact Person) (Phone)
APPLICANT SIGN.L 41100!",, ,,,D/� I p' /d 4014
APPLICANT PLEASE COMPLETE BELOW
El NEW CONSTRUCTION ['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
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
0 Mechanical 0 Radiation Fireplaces with Box Additions or
0 Air Conditioning ❑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 $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paidd 4/ Rec t No.1126N
Building Official Date Date/04 0, B
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372