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'ItVNE SO"t t"-
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec' d
I. Pink
2. Grecn
3. Yellow
File
City
Applicant
I PERMIT NO. Ofo . 6 q:f-
I
ZONING (office use)
A0L S6
LEGAL DESCRIPTION ("ffi"u~ "oly) ~
LOT BLOCK ADDITION
/
o~
(Address) b
:~~JL 5e
(Phone) loll. (3D. g414-
pITJ2P. 9t?). Idl!JO
I
5
APPLICANT j L .J I .
(Name )--------'=1I.lJ
(Address) l:5l OD
(Contact person)J
~PPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT D AL TERA TIONS
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
FUEL
OUTPUT
FURNACE MAKE AND MODEL
HEATING OR POWER PLANT
DWarm Air Plants
DGravity
D Mechanical
.Q,Arir Conditioning
DVent. System
D Steam
D 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
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 #
HEA TING PERMIT FEE
ST A TE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3Q.50
.50
4{).00
'<)ffice Use Only)
,'his Application Becomes Your Building Permit When Approved
Buildinl! Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372