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I;R,4 r CITY OF PRIOR LAKE Date Rec'd
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. HEATING/AIR CONDITIONING/FIREPLACE PERMIT
1
P I.Pink File PERMIT NO.
',NrlEsoi 2.Green City /5 1.521.
3.Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS /4.06 0 /DD' ow V' ' v ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) / fir- `G./" (Phone) 2-19. 941.1 Y7'
(Address) /121. GP� ///,' ' 4,7 >f// <-1-1 e„ .
APPLICANT )4,//z ' d 4^ .. ey4' (Phone)'c f 2 - 9 31- C)S.:44
(Address) d /4 e3;;-' / ..�- eu ,b
(Contact Person) &. ,r ' ° Z . /I (Phone)gj - e..4fr..- -,3-74
,-
APPLICANT
APPLICANT SIGNATURE _ , DATE ,-- e7,--/, ! i
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL Me.,-/r w ter/ /0a s°°,c)//s g/,tZZ'FUEL .�J�% .6 f
FLUE SIZE yi/ RETURN OPENINGS INPUT //,,,' ,=.o OUTPUT .41 .-;,-- >
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 Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildiings
0 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 $
STATE SURCHARGE $ 5.00 I
TOTAL PERMIT FEE $ i
This Application Becomes Your Building Permit When Approved Paid 5$S rt No. J
z4 sIII
Building Official Date Date l/` ' " , _
24 hour notice for all inspections(952)447-9850 j
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372