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#3465325 - 0010
04 rnro� CITY OF PRIOR LAKE Date Rec'd
411 t HEATING/AIR CONDITIONING/FIREPLACE PERMIT
444.
�� �� I.Pink File PERMIT NO.
A"N''':s* 3.Green App J� /141//�
3.Yellow Applicant l ( (t%f'�`'/
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
16187 NORTHWOOD RD NW ) )s
LEGAL DESCRIIPPT)ON(office use only) ` /
LOT / BLO :3� ADDITION PID2S— /7/ -6'4�///
0
OWNER ANDREW ZARRAS
(Name) (Phone) #612-900-4593
(Address) 16187 NORTHWOOD RD NW
APPLICANT
(phone)
#651-633-2561
(Name)_ Fireside Hearth & Home Phone
(Address) 2700 Faireview Ave N Roseville, MN 55113
(Contact Person) Leah Lodermeier I (Phone) #651-638-3312
APPLICANT SIGNATURE 1.,81/k L ad ernraiie-r DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Wann Air Plants ❑Steam Units and Fireplaces Cannot Encroach
• ravity ❑Hot Water into Required Side Yard Setbacks.
4 Mechanical ❑Radiation Fireplaces with Box Additions or
❑Air Conditioning .����: rices Cantilevers to the Outside of Buildings
❑Vent. System Other Devices Require a Building Permit.
FIREPLACE MAKE AND MELGARAGE HEATER HHT/HD75A
FEE SCHEDULE
Industrial,Commercial&Multi Fam 1%of job • Residential,Gas Fireplace $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 $49.50
Cost$ Buildi g Pe9,9101
IEATING PERMIT FEE $ c SU
STATE SURCHARGE $ ; i t 0
TOTAL PERMIT FEE $ ,
I •
This Application Becomes Your Building Permit When Approved Paid 1 Receipt No. If 0
Date ." By
Building Official Date _�
24 hour notice for all inspections (952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372