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04 rRlpii CITY OF PRIOR LAKE Date Rec
c HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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4,,vNE50-cP 1.Pink File PERMIT NO.
2.Green City /5; 937
(Please type or print and sign at bottom) 3.Yellow Applicant `✓` g /
ADDRESS ,
a�9 2 1/111 I ds ZONING(office u;
kJV
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name)
n,aha vd
6-res-(J (Phone) -'9-/-)-5/09
(Address) 2792 '/thid S Zane AW
APPLICAN'IT17-1,,,, - i l'77-7/4/"(--(— ,� �
(Name) , !V4 P� ` /
L / (Phone)' `1� � ?;� J
(Address) /i /,f-, . )(I (Jr 1�r , /� )(PP 5�'5 l
(Contact Person) L._ �1,_/ %x-;' r— . .-r--
�G (Phone)` t✓2 L- l J ,,
APPLICANT SIGNATURE / r if 1, IA.GLACYV DATE 8.-I? ' I
APPLICANT PLEASE COMPLETE BELOW
I !NEW CONSTRUCTION EPLACEMENT ❑ALTERATIONS
R
FURNACE MAKE AND MODEL CaY vie a 14/1-86330 3-fon 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
E Gravity ❑Hot Water
g_, echanical ❑Radiation into Required Side Yard Setbacks.
Air Conditioning ❑Special Devices Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
❑Vent. System
❑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
minimum
Residential, Heating &A/C (New Construction) $149.50
Residential, Heating Only(New Construction) $64.50 Residential,ACCOnly Residential,Additions
ly &Alterations $49.50
$49.50
Cost$ Building Permit#
HEATING PERMIT FEE $ I..P.9D
STATE SURCHARGE
TOTAL PERMIT FEE $ �
This Application Becomes Your Building Permit When Approved Paid
52)__51) Receipt N?6 7 (�'
Building Official Date Date cy 2 i `3_-- By C c//
24 hour notice for all inspections (952) 447-985011 `
4646 Dakota Street S.E., Prior Lake, Minnesota 55372