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0. PRI0 CITY OF PRIOR LAKE Date Rec'd
ti i HEATING /AIR CONDITIONING/FIREPLACE PERMIT
u WI
1. Pink File
"t rNNESO l r 2 . Green city PERMIT NO . e-12_97
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
D59 S CA'ems Ui&Q U..1‘
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER O ) ' t � ° I
(Name) •
(Phone) o� — is 1S ('
.:.(Address) ;515 \Dck,4 'I 'A • l 1:� (NI,) � ` -
APPLICANT � :) q)
(Name) , INI . ! ..L. 4' 1!1) d ∎! Phone) 6)52-- !
- `' 4
(Address) , MrBIll i 02 k 'D-
(Contact Person) (Phone) 9,S' — ? � -- ?- 7()
APPLICANT SIGNATURE _, DATE p//13
de
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT LTERATIONS
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
❑ ity ❑Hot Water into Required Side Yard Setbacks.
echanical ❑Radiation Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
[Went. System • Other Devi es ' ' Require a Building Permit.
FIREPLACE MAKE AND MODEL `k to N, VISM100
FEE SCHEDULE
Industrial, Commercial & Multi Family 1% of job cost • - • -ntial, Gas Fire ■ e $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 esl I ential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) , $64.50 Residential, AC Only $49.50
Cost $ B 'lding Permit#
HEATING PERMIT FEE $ 'SO
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid 3• Receipt No. 7 / �
Building Official Date Date /) J B � �
24 hour notice for all inspections (952) 447 -9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372