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CITY OF PRIOR LAKE
HEA TING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
i ~~w J~icant I PERMIT NO. (J7 o9Q t;!
ZONING (office use)
en') N~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(h~UlcuJ Frv..\; C~
I C:, 5/1 L~onS fN-e-
v
pno"--
(phone) 9<; z .. "1 '1 D - S I () 6
S S3'7 '2-
(Address)
Ct
APPLICANT
(Name)
(Address)
SEDGWICK HEATING & AIR CONDITIONING LLC 1
8910 Wentworth Ave. So
Minn~~~:~~OO~5420
(phone)
(City)
(Zip Code)
(Contact Person)
(phone)
L...\..-I:---. DATE
(i""l
APPLICANT SIGNATURE
SE COMPLETE BELOW
I DNEW CONSTRUCTION &REPLACEMENT o ALTERATIONS
FURNACE MAKE AND MODEL La..%wI (;;-y.. 6\, I MPV 3'" \6ll' I FUEL (; c"-~
QA
FLUE SIZE b RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants D Steam Units and Fireplaces Cannot Encroach
DGravity o Hot Water into Required Side Yard Setbacks.
123 Mechanical D Radiation
DAir Conditioning D Special Devices Fireplaces with Box Additions or
DVent. System o Other Devices 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 $
Building Permit #
HEA TIN G PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
ptNo. ~4-2-
BuUdin!! Official
Date
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372