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HEATING/AIR CONDITIONING/FIREPLACE PERMIT f,/9' If
drIh'NEsci° 1.Pink File PERMIT NO.
2.Yello Cpty / iI 7 /-
! ).Yew Applicant • La
(Please type or print and sign at bottom) /
ADDRESS ZONING(office use)
169 /o On lin Sof CZ- sE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Na 3(,)d/ q Ro/Jy Neyei' (Phone)
(Address) /tf' 9 in 00,-n5-01-7 `--'i• sE
APPLeCANT/� YL(Name) V/ G L .grep/( re Si/S, i, C (Phone) (93-c&y�U-�p crX� V
(Address)) /51 LW 1 /4w 6 E -Pd%�i--Li1� 5:53-7
(Address) (r City (Zip Code) "
(Contact Person) I f V / Q C (Phone) 0'0) r./6 - 7?- . a-
APPLICANT SIGNA T � ' - ' DATE - ��
APPL CANT PLEASE COMPLETE BELOW
ANEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE �li �j✓GC RETURN OPENINGS INPUT Z3 ,DO U OUTPUT /9, OOO
TYPE OF SYSTEM VM. 1 HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water
❑Mechanical El Radiation into Required Side Yard Setbacks.
DAir Conditioning ❑Special Devices Fireplaces with Box Additions or
❑Vent.System El Other Devices Cantilevers to the Outside of Buildings
1 Require� a Building Permit.
FIREPLACE MAKE AND MODEL u L/ ; el `xi ✓rIQC i
FEE SCHEDULE
Industrial,Commercial&Multi-Family I%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 $49.50
Estimated Cost$ /502) Building Permit #
The Minnesota Statutes SS 326[3.145
"St'RC'l-IARGE"has been chanced for one
HEATING PERMIT FEE $ year effective
STATE SURCHARGE $ .50 Jul) I,2010,until June 30,2011.
TOTAL PERMIT FEE $ The minimum surcharge for a"fixed fee"permit
(Office Use Only) is K,beginning July 1.291(1
This Application Becomes Your Building Permit When Approved Paid 54-Sb Receipt No(`L' 4 6
( J
Date "'
Building Official Date 7, ,,e:?,
', /Y
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 t
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372