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RCITY OF PRIOR LAKE Date Rec'd
...4.0 HEATING/AIR CONDITIONING/FIREPLACE PERMIT 9 Z Z,. 07
Q 67
'JvNESD� I.Pink File
3.GreeneACity pplicant PERMIT NO.09 0 751
(Please type or print and sign at bottom)
44 ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
O(N )R S't.-e- ()1c k17. (Phone) /95c)) 'f I7-83S/
(Address) Nat). C _
a ,
APPLICAN / ,-,p
(Name) tZ.<� a fet 5 •3c h t (Phone) (�7d1'5-CO b -C
(Address) q t VA ItO f t G c.7''s I r" SkjCe2 .55:3?..1
(Address) (City) (Zip Code)
(Contact Person) )1t CQ Ssse,r � (Phone) �� Si--9X
APPLICANT SIGNATURE / DATE 9 l ?
APPLICA k PLEASE COMPLETE BELOW
['NEW CONSTRUCTION El REPLACEMENT El ALTERATIONS
FURNACE MAKE TD MODEL FUEL
E RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
0 Gravity 0 Hot Water into Required Side Yard Setbacks.
0 Mechanical 0 Radiation
❑Air Conditioning 0 Special Devices Fireplaces with Box Additions or
:Went.System 0 Other Devices Cantilevers to the Outside of Buildings
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 $49.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $ '9% SD
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ,5V, Cot)
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid s.v. !� Rec ' t No.S-7,
7
Date 9 ZZ. G B
Building Official Date •
24 hour notice for all inspections(952)447-9850,fax(952)447- 45
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372