HomeMy WebLinkAboutHEATING 07-1022
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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Date Rec'd
I Pink
2. Green
3, Yellow
~:~ \ PERMIT NO. 0-' I OZ~
Apphcant ' I ,
ZONING (office
use)
ADDRESS
/5l, O~
CA'LMJ' .Mu iJrf
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
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(Phone) q,1 ~ If(,{J - -)"5 JJ
OWNER
(Name)
\ (Address)
,.-
/ ~~ oq Cl1c'M-.J(' IN!
)J/{
APPLlCAr-.
(Name)_
(Address)
Fireside Hearth & Home
20802 Kensington Blvd
Attn Danlelle Ostgard 9529856675
License # 20512060
Lakeville, Mn 55044
(Phone)
(City)
(Zip Code)
(Contact Person)
DATE 0 I~
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION RREPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM REA TING OR POWER PLANT
\PPLICANT SIGNATURE
(Phone)
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
OVen!. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
(;~ft - J{., '12 vJJ /yV ')
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$ y'\ _ '5il
$
$ Lti).Vj
.50
Date
Paid 40. (IV
Date I tJ. Zr. 01
(Office Use Only)
I This Application Becomes Your Building Permit When Approved
Buildinl! Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245