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o. "1°4) CITY OF PRIOR LAKE c. Date Rec'd
9 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
g 7 7, /t/
1.Pints File ^-
�INNESoWP 2.Green City PERMIT NO. `l gg.
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
145 E[kK' 5-E Rio( (fiirc
Ris.46
LEGAL DESCRIPTION (office use only)
LOT 3 BLOCK / ADDITION 04,4/ 7.. )l `,J 6,142L---- PID ,75.- Q 7b=De:)3—
if)
gTwNameMberf M C `fa4 (Phone JG 2,1k" 5(-) )
(Address)q L 5 (5O* 1 DE Pr/Gr L'l rP 5575
PL)Cr:. , 5 1 , (7r3a(q) Phone l52 ' L 9J5
(Address) 207f) P f bUr 0 DC 9137cI`
(Contact Person) Limo. _ (Phonec2 L�5 c359
APPLICANT SIGNATURE $ , L. 6 DATE
41
APPLICANT PLE , E COMPLETE BELOW
['NEW CONSTRUCTIONE LACEMENT ['ALTERATIONS
FURNACE MAKE AND MODEL CQXREP
fl ek 5gDLAcctv FUEL
FLUE SIZE RETURN OPENINGS INPUT ggC) OUTPUT OM
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
m_mchanical
avity ❑Hot Water into Required Side Yard Setbacks.
❑Radiation
Lid Air ConditioningFireplaces with Box Additions or
L
❑Special Devices Cantilevers to the Outside of Buildings
El Vent. System ❑Other Devices 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 $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $ 4q-co
STATE SURCHARGE $
TOTAL PERMIT FEE 5375-1g4b—
This Application Becomes Your Building Permit When Approved �� id�j , S-6ReceiptNo. / '7
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Building Official Date Date t ( t / 4 By _ A
f�
24 hour notice for all inspections(952)447-9850 l
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372