HomeMy WebLinkAboutMechanical 04-1037
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
10./1" 61-
ase type or print and sign at bottom)
JDRESS
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/05
(pj/ II do t.lO IA/" .fT,
~!~. I PERMIT NO. ()+ Id 371
Applicant ,
I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK I ADDITION tO~
d-lJd
PID
00 ~O+.. 0
OWNER
(Name)
(Phone)
(Address)
APPLIC~ ' J
(Name) t' \ C) t'"' W<... ~ ~A 1'<
(Address) / ~ S8 '1&~~/~ 6~0 ~ ~f-.,
(Address)
(Phone) <JS-:r'l'l')~/I2)
;Jr/~rU~ SS37
(City) (Zip Code)
(Contact Person)
(Phone)
DATE
-rtJ~r
APPLICANT SIGNATURE
r
APPLICANT PLEASE COMPLETE BELOW
{L--ElNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
KE AND MODEL FUEL
RETURN OPENINGS
TYPE OF SYSTEM
DWarm Air Plants
o Gravity
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
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Estimated Cost $
REQUEST FOR FINAL
INSPECTION SENT TO
1% ofjo HOMEOWNER 10-06
$39.50 n
$99.50 _ ___._w.....u, l"\UUllIons /5{. Alterations
$64.50 Residential, AC Only
Building Permit # (!) 4-_ f 0 J 7
$39.50
$39.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
(Office lIse Only)
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
--'-
l'his Application Becomes Your Building Permit When Approved
Date
Paid "1tJ; W
Date I (); lId) f-
Receipt NO'lY7.
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245