HomeMy WebLinkAboutHEATING 07-1027
CITY OF PRIOR LAKE
HEATINGj41R f(lNDITIONING/FIREPLACE PERMIT
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Date Rec' d
10.1,5.07
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2 Green CIty
3. Yellow Applicant
PERMIT NO'7, 10 Z 7
ase type or print and si~n at bottom}
.illDRESS
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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(Address) '\lC)\O S\.Jo..l~ \:-\\ ~W
(Phone) CZ$ ~ '-1 40 I 71 !
APPLlCAN.T
(Name) \J \ e...- (' e.D\:.- ~ (' ~...A\ 0 ~^ \ \l\r~ (Phone) q s:+ L.t l..t 0 ."S hd.-tJ
(Address) \ b l S-l ~l1r~",- ~___ _ __ P r IIn1 I aJ...L _ _ _ _ ~ _S ~ "372-
(Address) (City) (Zip Code)
(Contact Person) Vc.c.uJL \...) ~ e (,<2C~- t9 (f.-v\('c..Ck';U~one) _9s i}... Lt "'0 5bd.-O
APPLICANT SIGNATURE ~..un _ DATE ~ - [).;). -~7
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
JRNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation n
o Special DeviceB1 'f'() !D
o Other Devices 1:.
PLEASE NOTE: Air Conditioner
U nits and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL .30" ~.~CJi,
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
$~ff~O
Building Permit #_
Buildinl! Official
Date
$~~SO
$ .50
$ P'10. u tJ
Paid 1-0. 00
Date, 0 . Z3, 67
Roct;NO 542JS7
B(jr-_ I
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
(Office Use Only)
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This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372