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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. E:w J~icant I PERMIT NO. 07. 10.371
ZONING (office use)
l ~ Y b -, t2 'f' cA 0 ~-;c ~ s t2-c).
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
)' lA <~GlV1
\5'-16i
CYoSbl-€..
Q~ d Oa.-Ls
(phone)
Ci'S2- '-1'1r-"U L1 ~
(Address)
lieA
APPLICANT
(Name)
(Address)
SEDGWICK HEATING & AIR CONDITIONING LLC
d910 Wentworth Ave. So
Minneapolis, MN 55420
(05'2rB81-9000
(Phone)
(City)
(Zip Code)
(Contact Person)
loilz/Of
APPLICANT SIGNATURE
APPLICANT PLEA OMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL LLl/1Ylo>L 6(,,,, \,,_/,y?\J~6 B6/1 FUEL €;,~~
FLUE SIZE RETURN OPENINGS INPUT , \ t () CO OUTPUT b lot ~ c 6
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
DGravity
is Mechanical
~Air 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
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
$
$
$
~)q. So
.50
YD. uU
(Office Use Only)
BuUdinl! Official
Date
Paid -10. UU
Date ~
I(f 2 S . (
'No. S~64-t
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372