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CITY OF PRIOR LAKE Date Rec'd
° HEATING/AIR CONDITIONING/FIREPLACE PERMIT q` / 4/, a-
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1.Pink File PERMIT NO. J 5 ) 1 /O I
M,NNESo�P 2.Green City �j
3.Yellow Applicant (/
(Please type or print and sign at bottom)
ZONING (office use)
ADDRESS
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5517
� / �YSC- I 11SL
1J
LEGAL DESCRIPTION (office use only)
LOT � BLOCK ' ADDITION 4/&---5--5 113&.- „vim,/ 0/,,e_ /P_I/D 2.5--.0(p/" 005-d
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OWNER 0_,i4 el S / I ' ' (Phone) s 2 --k77-99 -
(Address) 55f Ill � r / l a IIA 5
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(Name) ANa* �� # Phone 05- '4 .9 --991XPi
(Name) 1. iYl `� `/L �� L ( )
(Address) 71 VASTMMIIIIIA r 1 0' / /U (55-3S��2.:,
(Contact Person) u �i � ' / (Phone) el5�� -'�-7�72
APPLICANT SIGNATURE 1 /Ile ' DATE 9/41) /S
APPLICA'T PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 0 REPLACEMENT ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS IN UT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
D G vity ❑Hot Water into Required Side Yard Setbacks.
echanical ❑Radiation Fireplaces with Box Additions or
Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL , s1'T' .)0 % 111 / _
FEE SCHEI)I
Industrial, Commercial & Multi Family 1% of job cost 'esidential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating&A/C (New Construction) $149.50 Rest•- '; , • e:. '• c Alterations $49.50
RP.Slflentic1 Heatin.a C)nly New Construction) $64.50 Residential,AC Only $49.50
The Minnesota Statutes 326B.148 Cost$ Building Permit#
"SURCHARGE"has been extended
The minimum surcharge for a 4EATING PERMIT FEE $ 9
" ;TATE SURCHARGE $ .00
fixed fee" permit is
TOTAL PERMIT FEE $
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This Application Becomes Your Building Permit When Approved Paid o Receipt N.. 'ri
Date By
Building Official Date A _ •
24 hour notice for all inspections (952)4,7-9850 /
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372