HomeMy WebLinkAboutMechanical 04-0045
Date Rec'd
CITY OF PRIOR LAKE
HEATING/AIR C'ONnTTTONTNcroTD~PLACE PERMIT
REQU~~T fql} fINAL
INSPECTION SENT TO
, ''\
at bottom) H~~EPWNER 01-~~
\ 5' L L\ I ~"Jo ocl ~\A.(,K 'T rtt--\ \
LEGAL DESCRIPTION (office use only)
~;e~ S:rz71 L
LOT ( BLOCK
ADDITION
(Phone) <'tfLl. - ~o \ - ~5 07
OWNER
(Name) '[) ~ lA. ~ ~
M L LOff""'......K
(Address) \ 5 '"2.1....\ I W 00 ~ \) "^ l.-v:..T r~~ \
APPLICANT \
(Name) (, \ 0 ~..;...;..., <\ 't\ t..G.s-\-1,.... <. l-h. V""""~ .r.... <......
J '
(Address) \ DO E l J.o-\&.,.jo 'D ('.', .,It
(Address)
(Contact Person) S \-l,.ue..
APPLICANT SIGNATURE
~. ~.~n ~:~. \ PERMIT NO. / J...... / / L-\
l, Yellow Applicant , '-1 ~---J ,
ZONING (office use)
~ () <> r l. ....... \t..L . IV',..)
(Phone) OJ 5 -1. - Y q L - "'2.l (p
T 0 r-~c..u--- 5' S 3S 2
(City) (Zip Code)
(Phone) C1 5' "'2 - z. q 1. - 7 1.. "> \
DATE t 1,,<../oc1
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT AL TERA TIONS
FURNACE MAKE AND MODEL FUEL N <0
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM REA TING OR POWER PLANT
OWarm Air Plants
OGra.vity
o 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
~~~
FEE SCHEDULE \\~S \\
I % of job cost Residential, Gas F;~- . ~\\;~ -( \~ ~ 0 n~
$39.50 minimum ~\\\S ~S) \)\J 611~~
$99.50 Residential, Additi C\;OSJ:J r('~ AI\
$64.50 Residential, AC On C~\"t }. - .JU
BOld" P . # \~~
Ul mg emut _
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
FIREPLACE MAKE AND MODEL Q", (.o..~ ~\ l'l!.. 3 c.:, ~ - A
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
REA TINO PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Iffiee Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
$
$
$
3q,~o
.50
i-l o. 00
ReceiPINO. ~/) y
By
-{)C-/