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� CITY OF PRIOR LAKE C/ Date Rec'd
U
1 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
1NNES6C
I.
Pink File I PERMIT NO.
2. Caylicant 7 I
3. Ydbw App /
(Please type or print and sign at bottom) ` /
ADDRESS ZONING(office use)
4f22 #1UMM1NIGBIRD 1RP L N.E. -PRIOR LAMS, w*4 55342
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) MAP4A€+ DEBRA MAXFIELD (Phone) 6012) (o3( ,-00$4
(Address) 4122 NUMM►NcBIRD 'GRAIL t.L . •PRIOR LAKE,MN 55312
APPLICANT
(Name) PRACTICAL SYSTEMS (Phone) 015 2.)c 33 -18(08
(Address) 443428 SRAM OAK ROAD tkOPKIKI5,MPl 553'43
(Address) (City) (Zip Code)
(Contact Person) SliARLA CONRAD (Phone) (0152.)C133-'18c08
APPLICANT SIGNATURE ( (j S Kms°n-O DATE 0-4/13-4/1
APPLICANT PLEASE COMPLETE BELO
ONEW CONSTRUCTION El REPLACEMENT ITERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑Steam
Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water
Virecchoziriol
0Radiation into Required Side Yard Setbacks.
ning ❑Special Devices Fireplaces with Box Additions or
❑Vent.System 0 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 Resi ti dditions&Alterations $49
Residential,Heating Only(New Construction) $64.50 Residential,AC On y $49.50
Estimated Cost$ 2,600.00 Building Permit #
HEATING PERMIT FEE $ .rr'0
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ( Receipt No. z[t a7
Date `�
By
� ✓
Building Official Date 8— �b
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E..Prior Lake.Minnesota 55372