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OCT. 8.2004 12:46PM METRO AIR 952-447-8126 NO, 655
CITY OF PRIOR LAKE
HEA TING/" Tn rll"\~TnYr'f'Tn"'..rT"u'" tr.<TTn~nT ACE PERMIT
p,
Date Rec'd
/0. B ()~
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/05
F~l~y, \ PERMIT NO.(J.~. (02- 2-J
Appl1ml q-
(Please type or ])rint and siga. It bottom)
I ADDRESS
. \Q -, 'b \ \-\', \ \ c.~ ~ ~ ~ S.(.
ZONING (office use)
J
LEGAL DESCRIPTION (office use only)
LOT 4- BLOCK {; ADDITION 1"/0/ t, /l J () (/171
PID -zz;-.O' 7/ICJ. (J
OWNER
(Name)
(Address)
\. ~'^\ ~\- ~ (\'"' ~ \. \~ l-
\.0 '1 '6 \. \\, \ \ c..r"-s\- s.- L
(phone) QS ~~ '-'I.\\) ~~ SI
APPLICANT SIGNA TUR
(Phone) ~S J.-" '^ ,. g \~"\
fr\ '(j'- \" \l hN S'_~ 31~
(CitY) (Zip Code)
(Phone) '\ S i:^- '^' ~ i -~\). '-\
DATE \ 0 - -, -. \.{
APPLIC~ . L. ~
(Name) <L ~.~~ \I\,'~ ..L.A ~
(Address) \ \0 ~ ~ <> \...!" \ \. \J ~rV.. \\ f~-
"J (AddreSS)
\~~~
(Contact Person)
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION REPLACEMENT 0 At TERA nONS
FURNACE MAKE AND MODEL (c,--,.~, - M 'If e . & Cl- \ \.( FUEL ~ '\"""'"
FLUE SIZE RETURN OPENINGS INPUT t\'\l at\~ OUTPUT']S t Ca~
TYPE OF SYSTEM HEATING OR POWER PLANT
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
REQUEST FOR FINAL
INSPECTION SENT TO
"T~1ER 10-06
l%of} IlOMEO"~ 1"1
$39.50 I
$99.50
$64.50
o Steam
o Hot Water
o Radiation
o Special Devices
,..... _.~
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
_ Required Side Yard
Setbacks
OWann Air Plants
OGravity
o Mechanical
.2fAir Conditioning
DVent. System
:l -r()~
FIREPLACE MAKE AND MODEL
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$39.50
Industrial, Commercial & Multi-Family
Estimated Cost $
Building Pennit # 0 4. I 0 2- '-
HBA TING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$ S q ..sC'J
$ .50
$~
(Offiee U,e Only)
This Application Becomes Your Building Permit When Approved
Paid
4/ti, (n-/
Receipt NO'6- -; cf' 7/
. 'f
By
Bulldin~ Official
Date
Date /cJ 6. (, f-
2.4 hour notice for all inspections (952) 447.9850, fa" (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372