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PRI CITY OF PRIOR LAKE Date IIec'd
°4' �' HEATING /AIR CONDITIONING /FIREPLACE PERMIT
d t- I. Pink Pile /3 _3i
fNNES� 2. Green City PERMIT NO.
i
i. Yellow Applicant
(Please type or print an sign at bottom) _
ADDRESS ZONING (office use)
3o 52-. Vi t t--7s - P-I bUE. CT . W
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Na IVk+'42 ST t (Phone)
(Address) 3 0 S 2 VJ t 1i`O'S ' D lal= c r NV W
APPLICANT ��AA ��, A � p, I' n
(Name) t"�Gly fJ� w j(,Q i 1 �C� (Phone) -L 2 ' '7�7 - 2-785
(Address) 7137 7 1, qD -b -- G _ ..,AV A / 55,375
��AA (Address) A (City)
2 , (Zip Code)
(Contact Person) Iv`+'t2.µ— w lice, (Phone) le 1 Z -�3L p` °S? ` 1 •
—
APPLICANT SIGNAT ' ,, ... ,&Ai At-.. - .. _ _' _
- _
_� .__ DATE _ _ __/ � .__ 3
APPLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION El REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
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 Box Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL 14. I ►ekf' ° TI} WV 1?-1 Vial- FALLs
FEE SCHEDULE
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
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit # `
The Min nesota Statutes § 326B. 148
"SURCI IARCir has been changed Ibr one
HEATING PERMIT FEE $ year effective
STATE SURCHARGE $ .50 .filly 1, 2010, until .June 30, 2011.
TOTAL PERMIT FEE $ stk 53 The minimum surcharge fora "fixed fee" permit
(Office Use Only) is Si, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid T ,3 ,.. 6 Receipt No gi q-7
p., �
Building uildine Official Date Date i jk50 1 By ? -
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 .
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 -