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V. PRIO CITY OF PRIOR LAKE Date Rec'd
t HEATING/AIR CONDITIONING/FIREPLACE PERMIT /0_2_7, is
U tr1
.Pink File PERMIT NO. /St /333
'�rNNESo��, 2.Green City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
scl x FSk .- la.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER A �"�
(Name) efy I/DP�^/ (Phone) 6 f ) �/a l c�
(Address) 5 /,.�.
APPLICANT r M
/''
(Name) //n2Ara/ fl' r14<0, / r (Phone) 1c -1&cr-9v .y
(Address) / 2{d ititie U
(Contact Person) 444C Si./4-,d(1 (Phone)
APPLICANT SIGNATURE DATE /O 79-7—/r—
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ,PREPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL 'S S 6 -1 C( FUEL AV l- 4-
FLUE SIZE S`t RETURN OPENINGS INPUT o,t!w OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
0 Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
Mravity ❑Hot Water into Required Side Yard Setbacks.
echanical 0 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
FEE SCHEDULE
Industrial,Commercial&Multi Family 1%of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid 50. 3Receipt No.32.6t0
Building Official Date Date /Q,a7. (5— By
24 hour notice for all inspections (952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372