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s .4,,;‘, -Ak‘,<.1 PRION, CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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n1fNNESO'�P 1.Pink File
. PERMIT NO.
2Green City I J Ai_ /
(Please type or print and sign at bottom) 3.Yellow Applicant / (� I
ADDRESS ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT 2—BLOCK / ADDITION e4---40/Ai At / / ID 025-- 302 - 494-Q
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��)R.fYla i1 knn 2� cU,( V (Phone)_�j� ._3rd 112
(Address) NM IE\\uie Oil W 6F P LA k 1(1(\/ ,cS3-12
APPLINT
(Nme)C M 9 0-(1114-i kl A C (Phone) �S2 Q
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(Address) I k L1, Al lX p ( G-026D YA�� I , Niii 55361
(Contact Person) V - \Q Y\ ( (Phone)
APPLICANT SIGNATURE 1 kj(AAtJY DATE(o711 (/3
APPLICANT PLEASE COMPLETE BELOW
: 1NEW CONSTRUCTION P/REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL oC( n ovA0'(0\I r 0X003 Ai FUEL ne .
FLUE SIZE RETURN OPENINGS INPUT (_kOl O3) OUTPUT apoo
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE:Air Conditioner
1t'ravi D Steam Units and Fireplaces Cannot Encroach
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❑Hot Water into Required Side Yard Setbacksor .
Mechanical ❑Radiation
LlAir ConditioningFireplaces with Box Additions
0 Special Devices Cantilevers to the Outside of Buildings
0 Vent. System ❑Other Devices
Require a Building Permit.
F C-E MAKE AND MODEL OC{.�.�, f NtW U??0
FEE SCHEDULE
Industrial,Commercial&Multi Family 1%of job cost Residential,Gas Fireplace $49.50
Residential,Heating&A/C $49.50 minimum
(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 $ LI oit s
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ .`>0
This Application Becomes Your Building Permit When Approved5-0 1 g5--(a
Receipt No.
Building Official Date D to 6 -\ck<< 5 By
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372