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CITY OF PRIOR LAKE Date Rec'd
TRIO
° ' H EATING /AIR CONDITIONING/FIREPLACE PERMIT
v I � ,
-4, - >.
i o o L. Pink File
'mss 2. Caeca City PERMIT NO. Ai_ .L70
3. Yellow Applicant
(Please type or print and sign at bottom) % ` .
ADDRESS (office use)
3 2_9 Je r er.5 C Pr; 0, La.tC,_ 3 7L -. - •
• LEGAL DESCRIPTION (office use only)
•
LOT BLOCK ADDITION PID •
OWNER ) Practical Systems (Phone) 7 5 2 "9J /86g .
4342B Shady Oak Rd.
(Address) Hopkins, MN 55343 .
•
APPLICANT Practical Systems
(Name) 4342B Shady Oak Rd. (Phone) 9'S2.- -- ./86c9 •
(Address) Hopkins, MN 55343
(Address) (City) (Zip Code)
(Contact Person) • / ke�J (Phone) 4 S . Z ,�
- 93 — /d`?I? t (
C
APPLICANT SIGNATURE " a'(1 " )1 DATE c — 17 — /3
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION .REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL - -
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Wat Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ chanical ❑ Radiation Fireplaces with Box Additions or
r Air Conditioning ❑ Special Devices
❑Vent System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
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 Minnesota Statutes § 326B. 148
HEATING PERMIT FEE $ l 9 j "SURCHARGE" lids been changed for one
year effective
STATE SURCHARGE $ .50 .luty 1, 2010, iintil June 30.2011.
TOTAL PERMIT FEE 5 S'7<37J The ntinitnntn sureliai-c,e fora "fixed fee" permit
(Office Use Only) is S5, hegiriiiing July 1, 2010
This Application Becomes Your Building Permit When Approved Paid ji / 1 71 Receipt NO. 9D r - /
Date /. / J By ` - � —
Buildine Official Date -
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 •
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 .