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CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
rNNBSD'S
2.
1. Pinken Filey PERMIT NO. j5 906)GreCit
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS6
17(6 2 n I ZONING(office use)
/3-e_ Sf.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(OName) ar\I
1 i 1`/1 Di.V\1Vl(t (Phone) -1�I 7 g f 7
(Address) 61 --0 Deese, S`. (u-E__-
APPLICANT
VEAPPLICANT '(-- ?5 -
((//
(Name) i ON) VI Or Ce/ (Phone) 5" ."(`i,
(Address) OC'n C U� vpi (-a /�a �-'vIIS 3 7Address
Address) (City) ( ( ip Code)
(Contact Person) I ' l 1 ( (Phone) 96-5a l` ( 3 )---al(r(-I
APPLICANT SIGNATU' 7 , t---
Q4(,e DATE
A 'PLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION (REPLACEM�ENT El ALTERATIONS
F -MAKE AND MODEL Cain ilf- 9 16B?�c q !q 1 C)n V.' FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
Mechanical ❑Radiation Fireplaces with Box Additions or
Air Conditioning 0 Special Devices p
Vent. System 0 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 $49.50
$49.50 minimum
Residential,Heating&AIC(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $ tlq,50
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt o.2_,..
Date rf �J By
Building Official Date Y , r r �S
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372