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- , p Rio CITY OF PRIOR AKE L..,_..._. ----- Paz.::._ Date Rec'd
° �e HEATING /AIR CONDITIONIN/FIREPLACE PERMIT
I
41 • INNEsoo 1. Pink File
2. Green City PERMIT NO / . , / J
+ 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS , -- .W..�.. 4 ZONING (office use)
‘. \, 17 r - Lt 1
r
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) ± ` 1 � (Phone) C .. -D 5-CX R
:. (Address - . _- : - . _ _ _ � ) 41/ ) ( r .n - - ; . *j- 1' ..,...14";. -
APPLICAN
(Name) I _ --
L (Phone)
(Address) 1, V � _
(Ad. -ss) / (City) (Zip Code)
(Contact Person) ® f'1� . ' Asc.- ' j . (Phone • � ' � � -,1 4-,\A
APPLICANT SIGNATUR DATE \\ ^ \ y 1
4 APPLICA ►,' -PL 4, : COMPLETE BELOW 4
❑NEW CONSTRUCTI o e.41 REP ' Co- 1 ENT ❑ ALTERATIO S
FURNACE MAKE AND MODEL ] ,o•- ,.g\' ^ — b, S - ''h „t ,C) \ eN E - 1 FUEL i 1
FLUE SIZE RETURN OPENINGS INPUT I \ l '1 OUTPUT 9 U W
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water
❑ Mechanical ❑ Radiation into Required Side Yard Setbacks.
❑Air Conditioning ❑Special Devices Fireplaces with Box Additions or
['Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
, - - FIREPLACE MA A ND MODEL :,
~ = P
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 $ 3) - ) Building Permit #
—C\,. .
HEATING PERMIT FEE
t. STATE SURCHARGE $ c50
� : • TOTAL PERMIT FEE $ S7
4= (Office Use Only)
This Application Becomes Your Building Permit When Approved Paid t Receipt No. , ,
h. Buildine Official Date Date i i y i � f : By , ' \. . , .. t
24 hour notice for all inspections (952)447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
, ta , 47 r't"rYts.,,0 'rt .51
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