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PR/o CITY OF PRIOR LAKE Date Rec'd
cft X 2 �e HEATING/AIR CONDITIONING/FIREPLACE PERMIT
I.Pink File
A'/n'uesoi° 2.Green City PERMIT NO. /(9 • 34-'
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 4565 HUMMINGBIRD TR NE ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER TOM &KATYGRAF
(Name) (Phone) #952-496-9991
(Address) 4565 HUMMINGBIRD TR NE
APPLICANT
(Name)_ Fireside Hearth & Home (Phone) #651-633-2561
(Address) 2700 Faireview Ave N Roseville, MN 55113
(Contact Person) Leah Lodermeier (Phone) #651-638-3312
APPLICANT SIGNATURE IA-a& d 6-/Tne-te-f' DATE 1/7/16
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Waris 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 Buildings
❑Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL HHT/ SAPH-D-CSB-IPI
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 Receipt No.3q ty
Building Official Date Date (L I c. i c, Bi
24 hour notice for all inspections(952)447-9850 C
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372