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171CITY OF PRIOR LAKE `./ Date Recdve HEATING/AIR CONDITIONING/FIREPLACE PERMIT
tf�knte sots I.Pink File PERMIT NO.
2.Green Cit} /�• ��
(Please type or print and sign at bottom) 3.Yellow Applicant
ADDRESS
�
' ZONING(office use)
153i iIP 6
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name) � id / r
`: (Phone) (Pi CJ 19 —ULco I
(Address cm , ss i`/ 13 Pt, • t
APPLICANT
(Name) Genz-Ryan i
(Phone) 9.59_767-1000
(Address) 2200 West Highway 13, Burnsville, 55337
(Contact Person) Autumn 952-767-1000
,
(Phone)
APPLICANT SIGNATURE InitiAALAM IL •M DATE r
APPLICANT PLEASE COMPLETE BELOW
ANEW CONSTRUCTION ii PLACEMENT
FURNACE MAKE AND MODEL I"'' ❑ALTERATIONS
FLUE SIZE � � "- • '� FUEL � C�-n��'
RETURN I PENINGS IN"UT
TYPE OF SYSTEM OUTPUT
HEATING OR POWER PLANT
PLEASE NOTE:Air Conditioner
❑Warm Air Plants QSteam Units and Fireplaces Cannot Encroach
❑Gravity DHot Water
QMechanical QRadiation into Required Side Yard Setbacks.
QSpecial Devices Fireplaces with Box Additions or
DAir Conditioning
Cantilevers to the Outside of Buildings
❑Vent. System ❑Other Devices
Require a Building
FIREPLACE MAKE AND MODEL
Building Permit.
FEE SCHEDULE
Industrial,Commercial&Multi Family 1%of job cost Residential,Gas Fireplace $49.50
Residential,Heating&A/C(New Construction) $49.50 minimum
Residential,Heating Only(New Construction) $64.50 Residential,Additions&Alteration49.50 $49.50
Cost$ Residential,AC Only ,
Building Permit#
HEATING PERMIT FEE $ LP/SCS
STATE SURCHARGE $
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid co MS
rpt No. .-1` /_ I
----
Official ,-----5w---- Date ' •'3k-Cc
Building `� I
24 hour notice for all inspections(9S2)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372