HomeMy WebLinkAboutHeating 07-1189
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CITY OF PRIOR LAKE
HEA TING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
jl,L-t ,ul
t ~ E;licanl I PERMIT NO. 0 7, / I 871
I ~~'=sor print andsl:at bottom)
'5 l"\ l\ C'.o ~__\Vv()~} l S~ ~ ~
ZONING (office
use)
~ \' ,~,.. \... Ii\. \~...l I IV"-. ~)
~GAL DESCRIP110N (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) be' ~ ..... \~" ~ ~\-....,.....s ~ ..'"
~\ 1- ~",.s -~~':5S
(Address) S \ '-^' ~
(Phone)
r--"'(j/'
APPLICANT \r:: . ~ ^' "")
(Name) ~..o.o.'\ ((......'\... ~~ '\~~'\-', I'V\ " l\...~ C~,,!-.: 1~hone)
t:\ S').-v.. '-0,,\ -"'\ "7 ). i? J
(Address)
~ 01, \~ '0 .-\'\--- <:;\-
(Contact Person)
Ci\ ~ ,l-,,\ ~\.....,-\ ')"'A
V IV\N s..s '\ )..'"\
, ' (City)
(Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE" -;)... \ '\. t\ \ ~ -,
APPLICANT PLEA COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL c:. FUEL ~\.V r.:.J
FLUE SIZE '? \\ ,p", C- RETURN OPENINGS INPUT \cQ) \PO OUTPUT <:;/\ ~::n
TYPE OF SYSTEM HEATING OR POWER P
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side YanI Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
DWarm Air Plants
~. vity
, echanical
, Conditioning tot L-- 6A D
ent System
FIREPLACE MAKE AND MODEL
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
FEE SCHEDULE
Industrial, Commercial & Multi-Family I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64.50 Residential, AC Only
$39.50
- <':::$39~!LJ
$39.50
Estimated Cost $ ~. \IfC:} \ ~ Building Pcnnit #_
.
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ ~~Y.D'O
$ ,50
$ ~~,..Q~
pllltl 1;cfO. OV
;Zc~eIPT 55/ J Z.
OIFlC: /2.2-7.(,1
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