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CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FlREPLACE PERMIT
Date Rec'd
/ ( I .Ji.I () 7
ADDRESS
\\ \.oY~D ~\u-\~. l\\Je
~.:i':n ~!~ I PERMIT NO.7' 0 ~J I
3. Yellow Applicant '.
I WNING (office use) I
~)( \ D ( L(<-..K (;::...., I nl \'.:) .
LEGAL DESCRIPTION (office use only)
LOT) BLOCK
ADDITION
Pill z,~ 1'1-. / 2., 'i. )
&=R Yo..vJt ~,€{\.bou--\ \-
(Address) \ \oLr~ D LeJ- -e.-
APPLICANT tl, --,' I r l - \\' . U:-;'7 ~ qQU~\ --7rj LI'
(Name) . \~\\\.~)\ L,~ \'\\ -e p ~-<-~ \)601). (phone) ---1'OL C -, d-_\C
(Address) e 31.9-2) ~1LUY 13 Lv Hl( r1SVil1f 5533 7
. (Address) (City) (Zip Code)
M Cc (phone) c::z -B9D.- 7 4!P
DATE 10
(phone) GJtZ-LlYl--2Y3l,
(Contact Person)
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL ~~ ~ FUEL 'j'
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants 0 Steam
DGravity 0 Hot Water
o Mechanical 0 Radiation
DAir Conditioning 0 Special Devices
OVent. System 0 Other Devices
FIREPLACE MAKE AND MODEL
L-d-~'
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.
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
$39.50
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3Q' . S0
.50
4D,CJb
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildin2 Official
Date
Paid 4-0 vQ.
Date/( _
I .1 . ()
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372