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oPR/08 CITY OF PRIOR LAKE Date Rec'd
A.°
x HEATING/AIR CONDITIONING/FIREPLACE PERMIT 0 , f ) ls-
4fINNEsolP 1.Pink File PERMIT NO.
2.Green City /
(Please 3.Yellow Applicant ` �+�
type or print and sign at bottom)
ADDRESS c ZONING(office use)
?S re. ne cirde �S t
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) M( ,( lAn c 1 lr/ (Phone) qSl CIL/7— O
(Address) I Ca g f?reJ C( fc[Q S 1.0
APPLICANT
(Name) nrics Heti LLC., (Phone) C152--311S-UD32.
(Address) 2(,pQq L HI?� 31�rnn vi 1 Ie 55331
(Contact Person) law n 10 ( r c C) fl (Phone)
APPLICANT SIGNATURE DATE &I Icel 15
APPLICANT PLEASE COMPLETE BELOW
El NEW CONSTRUCTION 'REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL gut)v D U q (QVA (Ti O2-! fl FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
El Mechanical 0 Radiation Fireplaces with Box Additions or
,E Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑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
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid. 3?) Receip o.
Building Official Date Date �6 �` By
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372