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of PR/04. CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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`lfINNEsol-P 1..GP;nkren AFile PERMIT NO.
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(Please type or print and sign at bottom) Yellow Applicant
ADDRESS ZONING (office use)
t (o aa(3 L4cesie(hue SE P54)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 2W', 06,10/5---0
OWNER �`
(Name) �R �1CA‘APO" (Phone) - CI:)--i
(Address) (a aO LLa sIAQ 412_S t
APPLICANT(r ` Co(Name) l\o N IZO(\ ( I c —1--10-- (Phone) 61)`- Y-9 a9
(Address) g'la- ,--kQSIZ.s ACLQ-. S\A re ''L S--Cr?
(Contact Person) V& 4 '-1.r s•, (Phone) 6 a-PQ W'-g? 9()
APPLICANT SIGNATURE Nil& DATE /0 "(�'a' -/
Cf
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLAC A NT ALTERATIONS
FURNACE MAKE AND MODEL (/�p( iv �c %8 W 4-/S--- FUEL )J Cd—
FLUE
SIZE 4 RETURN OPENINGS ----- INPUT '+5 OOV OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravityinto Required Side Yard Setbacks.
❑Mechaical ❑Radiation 9
Fireplaces with Box Additions or
Air Conditioning ❑� ecial Devices Cantilevers to the Outside of Buildings
❑Vent. System Lf"Other Devices j� � y�' Require a BuildingPermit.
FIREPLACE MAKE AND MODEL �" 0_ q
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&Alte ations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 1-0-
5 00
TOTAL PERMIT FEE $ G -(� �^
This Application Becomes Your Building Permit When Approved Paid
64/.
' Receipt p N�as52
Building Official Date Date /0...22.._/4/ By m
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372