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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
IZ. 4-. OCt,
t ~~w ~l~icant I PERMIT NO. (,. 10 7 ~ I
ZONING (office use)
\ 5'C'\0
S \L4l\~
M.. ~i'v~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2.5'. 143. o(,~. 0
OWNER
(Name)
~~D\I' ~ ~~ \L.()~'-D\.
(Phone) 11 S\-1.tJCI.- 4li"ll
(Address)
, \ v~
(Address)
~~ ~ ;)\~~""\.tJl~ ,\\wthv~ '\. At
t-:)ffi \LL"Av'c\t~p\/\. ~l....
(Address)
'1 ( f'f\Lf, \' LQ ~l ~ \o.~'<.~
- \I -- "
,\
SLt~A~ef~\C 'toS\-1-1!b._tlC\ l
~ "lY) ,. c.:.. <, C')
__-) \ r.'('-t~'-- __.J-> l '--'
(City) (Zip Code)
LC tA -1.-""1- 9J ./10-1 (
APPLICANT
(Name)
(Contact Person)
APPLICANT SIGNATURE
/DA TE
r--
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
OWann Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
HEATING OR POWER PLANT
o Steam
ti(j Hot Water
o Radiation
o Special Devices
o Other Devices
TYPE OF SYSTEM
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50, Residential, Additions & Alterations
$64.50 Residential, AC Only
$39,50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ .3\ ccC .(;f\::;
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'2fi. ~~
.50
40.C0
Use Only)
Date
Paid ~. OCJ
Date I z,. ~...() 6
5"l--6tY.
,nis Application Becomes Your Building Permit When Approved
Buildine Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245