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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
\lltt ltt \\
~. ~~~:w J~~icant I PERMIT NO. 7. / 0 7 ~ I
ADDRESS
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER .-<'-J-
(Name) ~/1tt
(Address) / .
(Phone)Q5d -~~c)'-7~C)(
(Contact Person)
J..41?ttc/
/
(Phone) q?,~,- 131 -5Y3;1-
/J 4~, wp/;& J/_ 714 /U 55/,;z t/-
'--'77 ...-- -~ (Zip CodeV
(Phone) 75.) -~/- sr3)-
~ DATE ~ ~
APPLICAN~ '71/~ ~
(Name) ~ dA-<..--
(Address) b'1/), 14t-l/, 5( u '
(Address)
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT D ALTERATIONS
FURNACE MAKEfND MODEL L'a-v~ ,111et/AO ?CJ'" /~ FUEL ;!l..d 4~
FLUE SIZE l' RETURN OPENINGS INPUT '?ti , ~ tJ ~ ~1ZtOUTPUT 5'& 0{)06n,
~ /
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
D9ravity
ti2f Mechanical
DAir Conditioning
DVent System
o Steam
o Hot Water
D Radiation
D Special Devices
D 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.
FIREPLACE MAKE AND MODEL
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
$39.50
$39.50
Estimated Cost $ dt?~tJ. t.1-
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ .W-50
$ .50
$ J/tJ, e
lice Use Only)
This Application Becomes Your Building Permit When Approved Paid 4() uV
City of Prior Lake Bldg. Dept.
Buildine Official 4646 Dakota Street Southeast
Prior Lake, Minnesota 55372
24 hour not Phone: 952,447.9850 7.4245
H FAX: 952,447,4245
Receip~ No. 55 (;04-
By.