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CITY OF PRIOR LAKE Date Rec'd
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0„, � � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
A tii
1.Pink File PERMIT NO.
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2.Green City ip
�jNNESo� 3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(office use)
ADDRRESSzcAsvexv\I v...,\o a 6
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LEGAL DESCRIPTION (office use only) // / ,/ PID �5� 395 oa1-0
LOT BLOCK Z ADDITION -2?�-��StJ ,�1 ��ll'
OWNER r :ono (OIC - ��t- Z (0
ame) ,\� 1. _pr
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Address) ? 7 IJP �1d - i'Y 10� r /
APPLICANT L,ORNSVILLE HEATING&A/C,INC. (Phone)
(Name) 3451 W.gur„sviIIC Parkway
(Address) Suite 120
Burnsville,MN 5533( (Phone)
(Contact Person) (952)894-0005 � ��'�
APPLICANT SIGNATURE 4 tI.I �i DATE
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION REPLACE ENT �o 0 ALTERATIONS
FSE MAKE AND MODEL VW....An �C\ D 3C) EL
T OUTPUT
FLUE SIZE RETURN OPENINGS
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
0 Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
0 Gravity O Hot Water into Required Side Yard Setbacks.
O Mechanical 0 Radiation Fireplaces with Box Additions or
O Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
0 Vent. System 0 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
$49.50 minimum
Residential,Additions&Alterations $49.50
Residential,Heating&A/C(New Construction) $149.50 Residential,AC Only $49.50
Residential,Heating Only(New Construction)$$ 64.50 Building Permit#
HEATING PERMIT FEE $ (PI 15-C)
TOTAL PERMIT FEE $ ` I O
0
This Application Becomes Your Building Permit When Approved
a 9 ,ct) Receiptg),v54S
Date 7i� • lS By
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372