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#3501093&3501097-0015
.11..!3-1°4 CITY OF PRIOR LAKE Date Rec'd
U
HEATING/AIR CONDITIONING/FIREPLACE PERMIT f. /S. /(
1.Pink Fite PERMIT NO. /�2.Green City , 35
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
15337 BREEZY POINT RD SE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER GENE&SANDY KLUN #952-428-8727
(Name) (Phone)
(Address) 15337 BREEZY POINT RD SE
APPLICANT
(Name) Fireside Hearth & Home (Phone) #651-633-2561
(Address) 2700 Faireview Ave N Roseville, MN 55113
(Contact Person) Leah Lodermeier (Phone) #651-638-3312
APPLICANT SIGNATURE /...bah L o-d e-rmeiel" DATE 1/7/16
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gravity DHot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL HHT/ESCAPE-130-F&NOVUS/ND135-C(X2)
FEE SCHEDULE
L}dustrial,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 $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ j
This Application Becomes Your Building Permit'When Approved Paid 5-t, Receipt 0.3q 40
Building Official Date Date 1 , i.5. 11, By
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372