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- przfr, CITY OF PRIOR LAKE / Date Rec'd
--4'
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
,I'or:irnke Hic PEIZMIT NO. o2q. f
, l.r
4/INNESOlis
I City
3.Yellow Applicant $ 0 20P
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
----__,
/53 56, t' /' .; .ezl 4 ZI I
.... /Go
-...
LEGAL DESCRIPTION(office use—on --,) --.... ---- --------T------
LOT BLOC,' ADDITION Re CZ 45-1 ,4-4.4 ND .395: w .
k...,
(Phone) 92. _,-- . 3.5z,/,a0 7
(A ddi ess / .,,. /X__
(Nallle) 4 Y,17477,-e_ 77/ele PI- 2j _ Whom') F-7- 0-3 ' '
1-- -
(Addresst5,-C) ___ • ..e of,,e,,,: _t____ . ._ ,_._ 7-- . .iit___‘ ,._e__.
45
(Contact Person) 17/1/1 --r) (Phone)
A PRI,ICA NT SIGNATURE ..,.., , .,..
DATE -;-'14q 7,5
APPLICANT PLEASE COMPLETE BELOW
iiNEW CONSTRUCTION 2TrEPLACEMENT OA CIERATIONS
FURNACE lVIAKE AND MODEL,A /:‹g____________ FURL g,...V S
Fl..UP:SIZE _RETURN OPEN NOS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
El Warn)Air Plants riSteam
Units and Fireplaces Cannot Encroach
Gravity
El I 1 o t Water into Required Side Yard Setbacks.
III I echanica I D Radiation
Fireplaces with Box Additions or
"F Air Conditioning DSpecial Devices
Cantilevers to the Outside of Buildings
El Vent. System O Other Devices
Require a Building Permit.
FIR ITLACH MAKE AND MODEL
FEE SCHEDULE
imlustrial,Commercial& Multi Family I%of joh cost Residential,Gas Fireplace $49.50
50.50 minimum
Residential, Heating&A/C(New Construction) $14950 Resident la I,Additions&Alterations $49.50
Residential, I kat Mg Only(New Construction) $.64.50 Residential,AC Only $49.50
Cost$ _ Building, Permit//
llEATING PERMIT FEE $ 1/9 5-62
STATE SURCEIAR(ili $ 5,00
TOTAL PERMIT FEE
_ -
11
This Application Becomes Your Building Permit When Approved A ai 45, 11.--cl."-- Receipt/1640,
k 6 .
I ate
A _AiliMilpv
Building 01Iicii Dm7
To — - iiii
24 hour notice for all inspections (952)447-9850
4646 Dakota Street S,E., Prior Lake,Minnesota 55372