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4 r CITY OF PRIOR LAKE Date Rec'd
° HEATING /AIR CONDITIONING /FIREPLACE PERMIT
'i'Nrvsse- 2. c Fc 1 PERMIT NO. // 704....
3. Ycllow Applicant
(Please type or print and sign at bottom)
ADDRESS 10E- ZONING ((Amuse)
& 5o 6 H r 6 oC N p1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER d I/ CZ ce j (4/ti 3 (p 3 D-"
(Name) M i
S 6 1 1
(Address) .
•
APPLICANT
(Name) Standard Heating & Air Conditioning (phone)
130 Plymouth Avenue North
(Address) Minneapolis, MN 55411 -3445
c - z656 (City) (Zip Code)
(Contact Person) ��— / �i• (Phone)
APPLICANT SIGNATURE '� -- _ - A _ DATE .at _
APPLICANT 71 A E COMPLETE BELOW
ANEW CONS 'i CTION ' REPLACEMENT 111 ALTERATIONS
FURNACE MAKE AND MODEL _ •s FUEL ti c✓Asn 7 g ets
FLUE SIZE RETURN b ' E INGS INPUT "c'CJ
17 O OUTPUT - 7 6 / a2z)
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Alt Conditioner
NWarm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
DGravity ' - D Hot Water into Required Side Yard Setbacks.
0 Mechanical ❑ Radiation Fireplaces with Box Additions or
DAir Conditioning 0 Special Devices
[Vent. System D Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi - Family I% of job cost Residential, Gas Fireplace $49.50
549.50 minimum
Residential, Heating & A/C (New Construction) 5149.50 Residential, Additions & Alterations 549.50
Residential, Heating Only (New Construction) 564.50 Residential, AC Only 549.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ • SO
STATE SURCHARGE $ - .
TOTAL PERMIT FEE $___,S. t i • So
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid3- co Rec • No. (G / 7 jj3
2�
Date / / B /
Buildina Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372