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CITY OF I'RI( THIS FILE HAS BEEN Date Rec'd
HEATING/AIR CONDITIONIl CLOSED DUE TO
INACTIVITY 4/16/2008
REQUEST FOR F
INSPECTION SENT TO El~icanl I PERMIT NO.5. / 17~ I
HOMEOWNER 10-06
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS'". 214. b ,,0
I ~=R ~~A(~~/UAJ
(Address)
(Phone) CJ-1J-'1"" -o/~/,J.
APPLICANT
(Name)
..~..-._- '~---'--" ---,--
r SEDGWICK HEAnNG & AIR CONDITIONING llC '
8910 'yVt:lllvvOlth A\'3 So
Minneapolis. MN 5tA20
(~1I~1-9000
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
DATE
APPLICANT SIGNATURE
[]NEWCO~N
FURNACE MAKE AND MODEL' 'A/t.I-
FLUE SIZE ft; If RETURN OPENINGS
TYPE OF SYSTEM
APPLICANT PLEAS COMPLETE BELOW
D(REPLACEMENT 0 ALTERATIONS
2t hlJ I./J../. .Ab S t) 4lJ FUEL
INPUT q~/)/)O OUTPUT ~/)bJtJ
HEATINGORPOWE PLANT
~ann Air Plants
09ravily
0'Mechanical
OAir Conditioning
OVent. System
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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
G39--5c}:J
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
~~
o
Estimated Cost $ J IJJ..? ,..
Building Permit #
lice lIse Only)
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~ ~...[o
4 .50
~~()
This Application Becomes Your Building Permit When Approved
Date
Paid 4tl-
Dat/,(._ Z-r /Ctf
Receipt No. Cil)<)2-<tjt-
By
Building Official
24 hour notice for all inspections (952) 447.9850, fax (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372