HomeMy WebLinkAboutMechanical 04-0874
CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT .ept1 "3 -f3Lflt
C \O">lL w,~-
REQUEST FOR FINAL I. Pink File I . ,~
INSPECTION SENT T ; ~~~w ~~~icant PERMIT NO. cJtj - 8-?7
ase type or print and sign at botton: H 0 MEO WNER 0
\ . ~DDRESS . 0 1-05 Z~G (office use)
. /ij~. K~
OWNER
(Name)
(Address)
PID
LEGAL DESCRIPTION (office u~ .smly)
So 05' OJ, II
LOT BLOCK ~ 0i>DITION
/ Vi) r;CJ
(Phone) Cf ~-;;. - ~;;J. - ~ ~~ / S
APPLICANT ---r- c:. ~ i'1 4'
(N ame) -..J i-- I \" '" I
IJ4 I- L/ 0 iLS: (;; }.J
(Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLICANT
APPLICANT PLEASE COMPLETE BELOW
ONE ONSTRUCTION REPLACEMENT 0 AL TERA nONS
AKE AND MODEL FUEL
OWann Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
INPUT
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OUTPUT
RETURN OPENINGS
TYPE OF SYSTEM
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
$39.50
$39.50
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
39,6LJ
L lJ .50
(, ;-
ffice Use Only)
~hi~ Application Becomes Your Building Permit When Approved
Date
Paid tto-
Date X,-3 {)'O
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372