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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~~~onw ~l~icant I PERMIT NO.Ol 0/02.4
:ase
ADDRESS
,~c510C? ~p~~ ~:~.
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
&=R /?~&~,.J
(Address) 5d ~~ Cii S, E.
(Phone)~~ - 4/4i{ - 7;;Z;J. 7
APPLICAN'C., .
(Name) VUt ~~ '~_
(Address) 6cr/~ /4t..-#'...fh 4J.
(Address)
(Phone) 9~d-- 0/-S7'3~
O_~< ~tl/r.u" /fA} r:r-/;1s/
~ (City)~ (Zip Code) /
(Phone) C;~;t-1!3/--ft3;-
e
DATE /& ',I"
(ContactPcrson) ~
APPLICANT SIGNAT
APPLICANT PLE SE COMPLETE BELOW
DNEW CO~ATRU~TIh REPLACEMENT D AL TERA TIONS
JRNACE MAKE AND MODEl~. -58"CtV&::<f'''.I-~~~~~'{~r
FLUE SIZE RETURN OI4:NINGS ./ INPUT OUTPU
DWarm Air Plants
DGravity
.Br Mechanical
DAir Conditioning
DVent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
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.
TYPE OF SYSTEM
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
/~A A.A, .9
Estimated Cost $ f:ZLVV_
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$ 30/- 5 0
$ .50
$ it) :.:!!-
(Office Use Only)
Buildinl! Official
Date
Paid 4-{J. CJV
Date / (). z...C (. 7
o. 54-&(g fR
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372