HomeMy WebLinkAboutHeating 06-0218
CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO 'ink File I PERMIT NO'/')/ J/CY
HOMEOWNER /0- oc.- ~~~:w ;~~icant V19- 0'-' 01
(
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
APPLICANTt--.- ' , n 0
(Name) \'- \ r {L.. ,( OL
(Address) I q '6 r f1 II- U Jill rIA fJ '/rJ 11 I}v ~
(Addres~
(Contact Person)
APPLICANT SIGNATURE
APPLICA T PL
DNEW CONSTRUCTION
FURNACE MAKE AND MODEL
~acxA
ZONING (office use)
PIDGt s=- /31- O{Jf
(Phone)
SA
I'
(Phone)
DATE
A ECOMPLETE BELOW
REPLACEMENT 0 AL TERA TIONS
FUEL
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
HEATING OR POWER PLANT
DWarm Air Plants
o Gravity
D Mechanical
DAir Conditioning
Yent. System
D Steam
o Hot Water
D Radiation
o Special Devices
D Other Devices
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
INPUT
OUTPUT
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
$39.50
$39.50
$39.50
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
"flee Use Only)
{his Application Becomes Your Building Permit When Approved
Buildinl! Official
Date
$
$
$
39- <)0
.50
lfO -
Paid Lj 6,.
Date 3 -"30-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372