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ov rRro�P CITY OF PRIOR LAKE.
��" � HEATING/AIR CONDITIONING/FI � Date Recd
REPLACE PERMIT
jNNESOtQ+ �ZZ. /�
1.Pink File PERMIT NO.
(Please type or print and sign2.Green City
ADDRESS at bottom) 3.Yellow Applicant OJr�'.
3729 M ror l Tad I NW F
tO (ate ZONING(office use)
LEGALRz-
DESCRIPTION(office use only)
LOT?? 4BLOCK ( ADDITIOI4V
PiYtcjylkeW b . it A) Plea a51 3 gS
OWNER MCCol e ����
(Name) ctroviP ,
Address (2� �C'1 r j (Phone) 22_________j___,7 . _____y______7g
Vail Nw c0 �re ,55'372-
APPLICANT
w yn,� ', /� �j� >/
(Name) I'I Lk ,v 1 to/
(Address) • C (Phone ' 1 e 0
� � (VC
(Contact Person) _
(Phone
APPLICANT SIGNATURE ft,j i
DATE 5 '1 q'1 _
APPLICANT PLEASE COMPLETE BELOW
FURNADCE NEW MAKE AND MODELCONSTRUCTION
L� tEPLACEMENT ❑ALTERATIONS
FLUE SIZE
RETURN OPENINGS FUEL
TYPE OF SYSTEM INPUT OUTPUT
s HEATING OR POWER PLANT
❑Gravity ❑Steam PLEASE NOTE:Air Conditioner
❑Warm Air
DIechanical Hot Water Units and Fireplaces Cannot Encroach
Air Conditioning Radiation into Required Side Yard Setbacks.
❑Vent. System Special Devices Fireplaces with Box Additions or
❑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
Residential,Heating&A/C(New Construction $49.50 minimum $49.50
Residential,Heating Only(New Construction) ) $64.50$149.50 Residential,ACditioOnly ys&Alterations
Cost$ Residential,AC $49.50
Building Penni
$49.50
HEATING PERMIT FEE $
STATE SURCHARGE
TOTAL PERMIT FEE $5 .00
This Application Becomes Your Building Permit When Approved Filtitiln IP
Receipt Noel
Building Official 1V/
Date
By I �=�
Mr
24 hour notice for all inspections (952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372