HomeMy WebLinkAboutHEATING 06-0599
CITY OF PRIOR LAKE
.tlEAlI1~G/Am CONDITIONING/FIREPLACE PEAAlll
Date Rec'd
(Please ~ or print and sign at bottom)
ADDRESS
/01/C1 .tiliflatL~~l/
I. Pink Filo PERMIT NO.~~. 5:/ Q~
2. Gr-. City . {
3. Y oUow Applicant
ZONING (office use)
LEG~CRIPTION (office use only)
LOTt-' BLOCK ADDITION d; {L0..0 /J (L-d~' Sll {Fiji] CL1!/lV]
pm {},& - 00 S--
g;=~'Vlihv$ }, t\JAW 'hfV~10V\1 (Phone)CJ5Z-44J-~.1G5
(Address) IG1M3i1 n~ol111YtS 'll4t;\ t; 1~'~J 0f;:)~77/
~~~tm -+IQA :aV1i/t~E \;\Villdfl(~h',one) 0/ i:1l-MO:S 71 c:z,
(Address) \CW~ll}~~L~~Yl.ft.lL\rL "Jr~l , ,)nll~~ 00~-"7/
(Address)' (City) (Zip Code)
(ContactPerson) jW(jVl Sd1u,L)J1.. . (Phone) ~.x t- c :]14
APPLICANT SIGNATURE -ZLVl{:tfl{QLf)~Ltlll / DA;';'_U J' jCiY,
APPLICANT PLEASE COMPLETE BELOW
[]NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
AND ODEL FUEL
mpUT OUTPUT
HEATINGORPO~RPLANT
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
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & NC (Nl:W Construction) $99.50
Residential, Heating Only (New Construction) ~A $64.50
t--:::: 0 U
Estimated Cost '" J ,
Industrial, Commercial & Multi-Family
$39.50
*Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Building Permit #
(Office Use Only)
is Application Becomes Your Building Permit When Approved
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
'J c.- c;-c.)
$ "Z:::j --{ .
$ .50
$ q,V.~
Building Official
Date
Paid , _
(/(j.
Date (~)~b
Receipt No. C
o /'?Gf'
I By ~~q
t/I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245