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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
//(,.D7
I. Pink
2. Green
3. Yellow
~I~y I PERMIT NO. 7-JO' L I
Applicant , ~"' r. W \0
ADDRESS
ZONING (office use)
I G, 8 Z 0 tJ ~ /IJ D
Lie
/h...L '
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
(Phone)
APPLICANT ';") _, .
(Name)~d-J,- tI~, 1~-5 c--J-f A,'",
(Address) 11oc.c.j (Jc /41''1 ,4 ve; ;t:: I
~ (Address)
fj2C/'-.~
(Phone)
L~~~t/(,{ ('
(City)
7Sd,-~B-~ ::AJJI
IIv ,sYc.'i'-(
(Zip Code)
(Contact Person)
(Phone)
DATE
APPLICANT SIGNATURE
/I-c:> -~7
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION EPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
HEATING OR POWER PLANT
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
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.
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
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3~5v
.50
~(). I/D
(Office Use Only)
Bui/din!! Official
Date
Paid 40 (/ U
Date!' I ..-
f- v . ()
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspecti s (952) 447-9850, fax (9 2) 447-4245
16200 Eagle Creek Avenu, .