HomeMy WebLinkAboutHeating 06-0902
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
10. S. CIP
I. Pink
2. Green
3. Yellow
~:~y I PERMIT NO. O&,07fJZ-!
Applicant
ZONING (office use)
l(~f'\C\o\.J \c.....nl. \\J ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25 31+.
I 0
OWNER a..
(Name) f lVC\) ~~d M()(~~~ ~D((.)u..",
(Address) 11.1 "lDi. l,^h C\lMJ ~ t ~~
(Phone) q'S Z. .. Lpi'- 5"' 2. '-I
APPLICANT
(Name)\O\-~ \ (owrv\.. {or-+-
(Address) "1DC:() \N. ."n~ +Ir c.-
(Address)
AJ tz:. ~
(Phone) 1 (0').:> - "?~l:6~' es?~
lJQ.Mj I \I\.A. Y'\ ~.,
(CI
(Zip Code)
(Contact Person)
(Phone)
DATE
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION PLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
DWarm Air Plants
OGravity
Q Mechanical
~ir Conditioning
OVent. System
INPUT
REA TING 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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
'ZS?::b. 00.
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3~.~U
.50
ir\O.oQ
(Office llse Only)
'his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid +0 . 0 0
Date /0. .::> . 0 ~
Receipt No. 524-t, Z-
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245