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O 4 PRIp� CITY OF PRIOR LAKE Date Rec'd
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� r�
�I�'NES��P 1. Pink File PERMIT NO . �
2. Green City � �
3. Yellow Applicant
lease or 'nt and si n at bottom
ADDRESS ZONING (oflf'ice use)
��� 7 l� J �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /�
(Name) ��1C� l� 'E � L.C� +—�S (Phone) CISZ ��-I � C� �CQ � I
(Address) ��a� � � �J�,� � � • � 3� �-
APPLICANT
(Name) $URNSVILLE WEATING 8� AIC, ING (Phone) a1S�- -��-I " C�'�
3451 W. BumsviNe Parkway
(Address) c�j�g�?0
�+�rncVlllg,lVllV s�3�� (City) (Z1p Code)
(Contact Person) � �C.` • (Phone)
APPLICANT SIGNATURE LY�,�(�,n�0 � DATE � �� � •
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
F��#�AKE AND MODEL ��-��� � �(l�-I "{7�i FUEL
FLUE SIZE RETURN OPENINGS INPUT 6�T "�,-}�n
�.�—
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
� Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEESCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residentiai, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ �v Building Permit #
The Minnesota STatutes § 326B.148
HEATING PERMIT FEE $ , J�� "SURCHnRGG" h�s been changed for one
STATE SURCHARGE $ � �gp year effective
July l, 2010, until June 30, 2011.
TOTAL PERMIT FEE $'�J� The minimum surcharge for a "Tixed fee" permit
(Office Use Only) is $5, beginniog July 1, 2010
This Application Becomes Your Building Permit When Approved Paid� , S'� Receipt No. ��,
a v
BuUdine Official Date Date � � � � � � B _
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372