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CITY OF PRIOR LAKE Date Reed
.,° R104, CITY
HEATING/AIR CONDITIONING/FIREPLACE PERMIT C
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1.Pink File PERMIT NO. �Q, s
`1rNNEso'CP 2.Green City 7
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING',(office use)
Lfcf�3 Or Si' 5t— Fro( LC1P
'P 2-
LEGAL DESCRIPTION(office use only)
LOT
3"BLD6 eiewrol<ct `-s4 6'!\ PID X5;AO—OS'0
PPt �{� t -'Cfti(((e rt d 1 (Phone)--C�m/ 2 f/`"6 5 2 2
1
(Address)LM ' CbK ST SE ?(O( OKF 5 Z
APPLI(Name) AN JV r5- Med/mot ( 992 5 8
(Name) vie Phone
(Address) 2020so(boyo Pvie Sato%..� �7q I/ '
(Contact Person) LW)Gt61 (Phon G �`C, 7J, l�e5 •
APPLICANT SIGNATURE DATE 11"3o -4 5-
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTIONJEPLA: MENT� ['ALTERATIONS
FURNACE MAKE AND MODEL Call rl Qin iii M •0 ,F UO
OUTPUT 5.4���
FLUE SIZE RETURN OPENINGS INPUT 0 IP
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.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
❑Air Conditioning 0 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 $ '1�
STATE SURCHARGE $ .00
TOTAL PERMIT FEE $ 71=1
This Application Becomes Your Building Permit When Approved Receipt '1'No.'e t
at l� By
Building Official Date (t)
!1% Cj+' - 0
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372