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o1 PR/04. CITY OF PRIOR LAKE Date Rec'd
�� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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41INNEsolP' t.Pink File PERMIT NO.
2.Green City f j4 _
(Please type or print and sign at bottom) 3.Yellow Applicant / '`"29 9
ADDRESS
\--1- --)---) 'AtN1,zon r k SC NINE(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name) `eAV clejv-k\lif_r- )° ��-D3e'(Phone) S 1_ SI gq
(Address) \---\4-"ini -k- aZ.CXI l S E t RVCV (C . 1 ial . -3--) ),
APPLICANT BURNSVILLE HEATING&A/C,INC.
(Name)
3451 W.Burnsville Parkway (Phone) cls-2___n .F. j
(Address) Suite 120
Burnsville,MN 55337
(Contact Person y\_p\C
(Phone) v(
APPLICANT SIGNATURE 1P2A no,P-- 0(-r1
th\ekr---) DATE q17t IL-j
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION
F441kNOrett=MA:Kg;rggcnopF4, PC_ UREPLACEMENT ❑ALTERATIONS
FLUE SIZE 3�� 4:1_,(1-1-- 6 13—b3C� A- A C,t�J Imo,
RETURN OPENI1�GS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
PLEASE NOTE:Air Conditioner❑Warm Air Plants 0 Steam
Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water
into Required Side Yard Setbacks.
❑Mechanical DRadiation
roAir Conditioning 0 Special Devices Fireplaces with Box Additions or
❑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
Residential,Heating Only(New Construction) $64.50 1;49.50
Residential,AC Only 949.50
Cost$ '4C ES Building Permit#
PERMIT FEE $ (--k4,St)
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 'L.'L`St"
This Application Becomes Your Building Permit When Approved Paid
sy 3—J) Receipt No. /'/�'/)
Building Official Date Date B4
� / > / l/
,—
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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