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CITY OF PRIOR LAKE Date Rec'd
Id°,66 0'1,7°4' ,,, HEATING/AIR CONDITIONING/FIREPLACE PERMIT 9_ 9_ /4-
6,f,'ALA
I.Pink Pile PERMIT NO.
et1A741$01t. 2.Orem c /ii Ci K', /
3.Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS ZONING(otlice use)
g2ia`l (A)1,
IdS 0V�iook. /'V -
LEGAL DESCRIPTION(office use only)
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LOT / BLOCK ADDITION * LU/��!S%j f I�j i 1 PID "?P-- ge ,45-e,
(Name)OWNER
11160 i r) ` TCty)K)(z. (Phone) c�Z -yy S 1,7
(Address) 14 2 LC7 WI !CIS` Ot, c Y
APPLICANT AIR MECHANICAL INC1l,�
_
(Name) 16411 Aberdeen street P1E (Phone) �1p3Ezi ,7-7T 7
(Address) n_ Ham Lake,MN 55304
(Contact Person) l_,kJ I / I,f (Phone)
APPLICANT SIGNATURE j1jpi
itQ/l�(�\�
,t DATE /////q
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION 7iREPLACEMENT [}ALTERATIONS 7`�!
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FURNACE MAKE AND MODEL .TO2.. C8- FUEL
FLUE SIZE RETURN OPENINGS) INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
DWarm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
■ gravity Hot Water into Required Side Yard Setbacks.
• ►'' echanical Radiation Fireplaces with Box Additions or
•Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
0 Vent. System 0 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 Permitil
HEATING PERMIT FEE $ 49
STATE SURCHARGE S
TOTAL PERMIT FEE $ S�
This Application Becomes Your Building Permit When Approved MEM Receipt Ho
Building Official Date 1��� By ..g ,
24 hour notice for all inspections(952)447
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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