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CITY OF PRIOR LAKE Date RecdHEATING/AIR CONDITIONING/FIREPLACE PERMITzl / /Z ,pC�*NESO
21. Pinrek en CiP,ety PERMIT NO-07 0009
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3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office
/7 7ii 5, e 1,,,,..)c-)2,,i55 / r C, use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,-, L'
(Name) 3L - - 0L5 I (Phone) 9)Z--7 T .1‘91'
• (Address) / ! Z 2 c ✓C bt 1 )e4"Ad) #41(i
APPLICANT j . I•} e liovi (P� 1_ (t3 -J4 2
(Name) F1 QC 5 i iX ti f\ (Phone)
(Address) S--
00 F A' IA)1 L A ! ,U ' 5�,V t U.LS (A - -3 i /3
(Address) (City) ,�l- (033-1 oLI(Zip Code)
(Contact Person) Jo c od (Phone) (oi
APPLICANT SIGNATURE l - DATE
APPLICANT PL ASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants 0 Steam PLEASE NOTE:
❑Gravity 0 Hot Water Air Conditioner Units
0 Mechanical 0 Radiation Cannot Encroach into
❑Air Conditioning 0 Special Devices Required Side Yard
❑Vent.System 0 Other Devices Setbacks
FIREPLACE MAKE AND MODEL -',P-‘-t0 604,1461.d ydf 'S
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace
$39.50 minimum
Residential,Heating&A/C(New Construction) $99.50 Residential,Additions&Alterations $39.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $39.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $ #9. 50
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 50. 0 C)
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid vo Receipt No. 5726
Date /Z. a y By fifet--,
Buildin¢Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245