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04 vR15 CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Reed
Z3 V
/2_, is . 7
41Ih1YES0*
' ��` F`iy I PERMIT NO.
2.Grcca Ci I 03/
(Please type or print and sign at bottom)
3.vdlo.. Applicant
ADDRESS
/5 5 �i� id�,1 v�c� L� SE. /I Z NING Office use)
lif'/oe" /,�/eG-- , irn/ 551.322
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name) / /7,e12Gc/ 4-/L,esc,"/
(Address) /SI 53 G-',/dcc>ooc/ ! t SL:
K (Phone) (6/-2) G 1 S 723 0
f
,1/i1.✓ 55 3 2
APPLICANT
(Name) 4/2/ChQt/ ��fers ori (Phone) (&12j 6g S-- 793 D
(Address) /5-653 /J1/CfcAioc,c/ /li'r Sf- ,foe /i9i'E 1 ,41/'J
' 7
(Address)
(Contact Person) (City) (Zip Code)
(Phone)
APPLICANT SIGNATURE _____, --)7.-t:€--1-AZ,--t------------'r '�'
DATE /a1 P/0 9
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION [REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL (- n, �,r/m a/1 C—/1/-1ti-
FLUE
FLUE SIZE _5,i7fc
TYPE OF SYSTEM `� FUEL Na ui z/ �7�5
RETURN OPENINGS Slan�c` INPUT OUTPUT
BEATING.OR POWER PLANT
OWarm Air Plants
❑Gravi PLEASE NOTE: Air Conditioner
0 Steam
ty ❑Hot Water Units and Fireplaces Cannot Encroach
Q Mechanical Air Conditioning
0 Radiation into Required Side Yard Setbacks.
0 Special Devices Fireplaces with Box Additions or
[]Vent.System ❑Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL Require a Building Permit.
Industrial,Commercial&Multi-Familu FEE SCHEDULE
Y 1/o of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&A/C(New Construction
Residential,Heatin OnlyConstruction) $149.50 Residential,Additions&Alterations $49.50
g (New Construction) $64.50 Residential,AC Only
$49.50
Estimated Cost$ 49 5-6 Building Permit #
HEATING PERMIT FEE $
FD . bl\))
STATE SURCHARGE $ .50 4 01 • ( O3 1
(Office Use Only) TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid
Bulldlne Official Date 12,(.� U g By
Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 mill-Ili
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372