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of PRr04 CITY OF PRIOR LAKE Qj Date Rec'd
t HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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1.Pink File PERMIT NO.
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NNESO 2.Green City 15j ,9e
3.Yellow Applicant `t/ �cJ�
(Please type or print and sign at bottom)
ADDRESSZONING (office use)
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AD (1055-0-MiraDRESS ,
3-f- S pa Lak-P 55372 put>
LEGAL DESCRIPTION (office use only)
LOTif BLOCKS ADDITION a 40'6 t � 401PID OZ✓-- D?r-O29--c7
(Na,e)NER latIPeft VC-ter (Pho'neq20( 6
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(Address) -1 ` I CrO5Dadra 51 SE Wb tW 5-5-97
APe)CANT ! lC /
mki ! i Vvi �( G11 (Phone(./Llitf- 0555
(Address) `Cb C t(U(7 xr i V
(Contact Person) (Phone - , j.
APPLICANT SIGNATURE KOLA. DATE CJ-a0'ICj
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTIONRPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL Chn e r b$CTL t,oct0 FUEL
FLUE SIZE RETURN OPENINGS INPUT Ct(9,OO7 OUTPUT 30,000
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Eu croach
ravity 0 Hot Water into Required Side Yard Setbacks.
Mechanical ❑Radiation Fireplaces with Box Additions or
❑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 $ ilq.15D
STATE SURCHARGE $
TOTAL PERMIT FEE $ 51. .tt
This Application Becomes Your Building Permit When Approved Ni,.:. s![� Receipt Nt. a,'
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Building Official Date •ate -
Zt 6...-
By 5-()(-74,
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372