HomeMy WebLinkAboutHEATING 06-0075
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~e:n ~::y \ PERMIT NO. /T) 1..- n j---- I
3 Yellow Applicant (,/ (c;. I - J
(Please type or 1;Jrint and sign at bottom)
ADDRESS ZONING (office use)
5'" tf/ C~LAJ(){)d- T~tLi I
LEGAL DESCRIPTION (office use only)
LOT I BLOCK /-( ADDITION ,,~C ~ d
fJ C1:~"- L~ 8 rc-i
,
PID cJS- diLl {=3 L)-(,)
OWNER f'. ...-.--, /} J IJ'J) A/l
(Name) 0 h M _ VV1.^-1~r I
. (Address) 6/P L{- / l~~d/l %/AJI)()1"f IVa J' I
(Phone) qs2 .~.3.~~56 ./1
APPLICA~ -.J 11-./
(Name)-lOlA YVlSJLLL! E: ~-I-i na ~ !6 (Phone) q5~ - 8qt./- (){)()5
(Address) 61./51 vJ {2wrns-iLlie eJclAN g,uyosvil!('; ~S,,3;?L
(Address) J (City) (Zip Code)
(6eJ-h . (Phone) q 5;{ ~ gpf- f5lJlJS
APPLICANT SIGNATURE f3~ IV 1'~l-c:vS'6Y7 DATE 1/;;:;-iR /~
i I
APPLICANT PLEA~ COMPLETE BELOW
DNEW CONSTRUCTION M ~PLACEMENT 0 AL TERA nONS
FURNACEMAKEANDMODEL ~Y) n D~ G 4bltlH:~I/]{}~D{D FUEL
FLUE SIZE RETURN OPENINGS · INPUT l;q,. f57fD _ OUTPUT 54'. DlfV
TYPE OF SYSTEM HEATING OR POWER PLANT
(Contact Person)
OWarm Air Plants
OGravity
o Mechanical
nAir Conditioning
OVent. 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
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % 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
$39.50
$39.50
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ ,~q ,5D
$. ; I' .50
$ t-tD. (5/)
.
(Office Use Only)
is Application Becomes Your Building Permit When Approved
Building Official
Date
Paid iI(j ___
Date ,
d" L?-(j (,
Receipt No. .
::;- C:3 ~S:-3
BY~
(; .
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372