HomeMy WebLinkAboutHEATING 05-1037
THIS FILE l-IAs
CITY OF PRIOR LAKE CLOSED DV BEEN
HEATING/AIR CONDITlONJNCwIFlRF.T INAC11vJTy :i~~08
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 10-06
:c'd
()S
~!~. I PERMIT NO.~5. /~ '7Z-1
\pphcant . U
ZONING (office use)
1+.355 eAV~N' c:r
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZS- 3'-8 02.5 <::
OWNER
(Name)
(Phone)
(Address)
~;;~~AN~V~'t-
(Address)
(Address)
(Phone) 9S- d- -j/>-(5"=- Y9J ';P
..IJ'~. /777
(City) (Zip Code)
(Contact Person)
PPLICANT SIGNATURE
(Phone)
DATE
DNEW CONSTRUCTION o REPLACEMENT o AL TERA TIONS
FURNACE MAKE AND MODEL IjAl'U'r8? ~/fI77l.. FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants o Steam PLEASE NOTE:
OGravity o Hot Water Air Conditioner Units
o Mechanical o Radiation Cannot Encroach into
OAir Conditioning o Special Devices Required Side Yard
OVent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
yesidential, Heating & AIC (Nl~w Construction)
\. 'Hesidential, Heating Only (NeW, Construction)
\~\'l~ "..,J-
Uo.~ t Estimated Cost $
~f~~
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
lice Use Only)
~"
rhis Application Becomes Your Building Permit When Approved
Date
Paid __I
rt.vu
Date/d.lT. ,1'
Receipt No. S()ju
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372