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2002
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is, CITY OF PRIOR LAKE
,-�,'/� y Date Recd
�, / HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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1. pink is
z. Green City PERMIT NO. 1 6 . -.7
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
etof tJ*d ic�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER , �j G� //
(Name) 9 t:c.4 1 I CSI +v u 1..( � (Phone) / • .1. `J1 . 1L---
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I
(Address) [r.11
APPLICANT G.V. HEATING &AIR INC.
(Name) 5182 WEST BROADWAY (Phone)
(Address) CRYSTAL, MN 55429
5"2000 (City) (Zip Code)
(Contact Person) 4
/ (Phone)
APPLICANT SIGNATURE �' / L / DATE /
APPLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION �� 'EPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL Lt A )( LA /%Z7L(-1-1 0700/5t, `LJ FUEL Le,t/
FLUE SIZE RETURN OPENINGS INPUT 10c)L OUTPUT (ill 2,0u
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TYPE OF SYSTEM HEATING OR POWER PLANT
E. PLEASE NOTE: Air Conditioner
• arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach Gravity ❑Hot Water
■ ►i echanical El Radiation into Required Side Yard Setbacks.
ti ,it Conditioning El Special Devices Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
❑Vent. System 1=1 Other Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL 1
FEE SCHEDULE
Industrial,Commercial&Multi-Family l%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 $ U' O i , 0
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ G' ( j`
00
(Office Use Only) V{
This Application Becomes Your Building Permit When Approved Paid Receipt No.
p 4036
r_ By jjailb... .
Building Official Date Date t�} I i (Q 24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372