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PR � CITY OF PRIOR LAKE Date Rec'd
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5 e HEATING /AIR CONDITIONING /FIREPLACE PERMIT 7 3 0 ,10
z -) , .,,,,y
jNN . . p;nk Green City / File J ' PERMIT NO.
A-
3. Yellow Applicant ! � /
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
a00 t u,r L S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N ) S1 6 60.- rL f if (Phone) - 1 D ' `l .5 1
(Address) CJ (Ain H I.0 )(1 u ) • J C
APPLICANT (� \ „� i \ N , 1
(Name) E n an (Phone) �l JU V
(Address) 92 i)O I'1 lAiW 31r S 1
rk \i 1 M 3 -7-- )
Address) (City) (Zip Code)
(Contact Person) k ae--- e \� ��\ (Phone) C I51 LO ,k at)
A
APPLICANT SIGNAT ' -iri i`: " Z _M'A ' II DATE 1- 't
APPLICANT PLEASE COMPLETE BELOW
❑NEW CO STRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL U,KA — E 1V\ PV 61 d FUEL 44
FLUE SIZE RETURN OPENINGS INPUT 9 OUTPUT 1 U
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 El Special Devices Fireplaces with Box Additions or
OVent. 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 $ 5 64 I )O ;--- Building Permit #
HEATING PERMIT FEE $ 9-q.5
STATE SURCHARGE $ 6 -
TOTAL PERMIT FEE $ 5j .5
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ,..5 Re t No. C� j / 0 /7
Date 3 0 , 1 0
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