HomeMy WebLinkAboutMechanical 05-1114
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
1/,7,05
(Please type or print and sign at bottom)
I ADDRESS
~ 173 loath. SfV' {J~-t-
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNEP" 16
~::y I PERMIT NO. OS: / / /4-1
Applicant
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z5, /2. 9. ()6/.. ()
OWNER
(Name)
scott
rv i ~ \S t'JI\
/!/7J th..
APPLICANT , lilt ~ jj _ n ....,
(Name)=S' V'P ~ t (J Il n-e.(I r J -n ~ I() Wtl../ (Phone) '"15,.. ? J~ - 77rL2/
/4 "5 ctc( ~d~~)1;Yl!J I-oVl p/-v ~ , Sf) ~g~ /2,1 fttjf/, ;!!:.l: 7;
l' (Phone) f/.!7).- 73(0 - ?"7r;/
:l-h OS-
(Address)
95;J. ..... )/
(Phone) /J.J:J.. .... 0& '{ 3
(Address)
"'PLICANT SIGNATURE
DATE
(Contact Person)
APPLICA T PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
DWann Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
1-
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
y
,~ .~ O'f- E",im"ed Co", $
~{~.
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3C1,SO
.50
~,(/U
. _Alice Use Only)
This Application Becomes Your Building Permit When Approved
Paid
-
Receipt No. 5D3C, 7
By
Building Official
Date
Date _
/ /.. 1. O!:J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372