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04 rRro�� CITY OF PRIOR LAKE Date Rec'd
6 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
4„,vNESO�A 1.Piny File PERMIT NO. — /
�.� 2.Green City I /
¶C.L ` 3.Yellow Applicant ,. �/ I
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
R2
LEGAL DESCRIPTION(office use only)
LOT ' �OC'I�" 9 ZDDITION PID z 5--
,357 0/3—o
(Nam)R )tOUA COVOU It
,� (Phone)
(Address) N.e`))7 R\ira Y{ 3 V
1
APPLIC#, T i i�� i
(Name) U tKU vv kAJ 4 l v (Phone) ( - 3 7 - lvt 7
(Address) tc 6 u U (k 7
(Contact Person) (- A 1 tf (Phone)
APPLICANT SIGNATUREC/O\-- ��_ DATE 6i--Th
fir
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION NIRkPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL I U .,k\Ltk i L \J COU O 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
• cavity ❑Hot Water
il echanical into Required Side Yard Setbacks.
���� ❑Radiation Fireplaces with Box Additions or
ir Conditioning O Special Devices
Cantilevers to the Outside of Buildings
❑Vent. System ['Other Devices
FIREPLACE MAKE AND MODEL Require a Building Permit.
FEE SCHEDULE
Industrial, Commercial&Multi Family 1%of job cost Residential, Gas Fireplace $49.50
$49.50Residential, Heating&A/C (New Construction) $149.50inimum
M
Residential,Heating Only(New Construction) $64.50 Residential,ACCdOnly Residential,Additions&Alterations $49.50
$49.50
Cost$ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid sb .
R ei t No.2111,
Building Official Date Date � l
B •
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372