HomeMy WebLinkAboutMechanical 03-1432
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-05
1-/1+ f>U/1s"/1/t1T SI Se
hE~L D7fCif:TION (office use only)
rrO~;) BLOCK d-..- ADDITION
OWNER
(Name)
(Address)
(Contact Person) ~
APPLICANT SIGNATURE
Date Rec'd
/ (). 24-, ().3
:n ~!;y I PERMIT NO'03-/A-12-1
ellow Apphcant . T ~
ZONING (office use)
l~
PID-zS":" octP. 0/1 .. 0
(Phone)
01} lti K-
(Phone) -9 n-..l{4l"'~7t, 1-
~ 5~1
(City)
(Zip Code)
(Phone)
DATE
A: PLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
OUTPUT
OWarm Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
MAKE AND MODEL
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
'tee Use Only)
INPUT
.f3 REA 1ING OR POWER PLA,NT
I) e.4.U't=J~rtamFvr PI ~~~ --r P~EASE.~OTE:.
- U ~t ~ I fr> AIr CondItIOner Umts
:;j: IV'S 10 0 AJ Cannot Encroach int')
J1() Cl SJl'fill.I~e . Requirecl C" .
Tr mO atk'e~ es C' ~~
1\~S \\~
IS ~\\.;~ ~~ '{O \)~
FEE SCHEDULE 1\\ OS~\l \l 1\/16/1.\)
I % of job cost Residential, Gas 1 C\.; ~\"\l\'{~ ~
$39.50 minimum "'(~~C).
$99.50 Residential, Additi. ). $39.50
$64.50 Residential, AC On, $39.50
Building Permit # O'J -I +-? z-
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3 4.S"O
$ .50
$ ffl.OO
paid4-0. d 6
Da, O. z,~.O?
This Application Becomes Your Building Permit When Approved
Receip~ /8
By
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372