HomeMy WebLinkAboutHEATING 06-0376
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
S-;/$: O/.e;;
(Please tvPe or print and 8i~ at bottom)
ADDRESS
I!IrPt.{Ij,r,i>lR ~'l- ''''''dhL A/L
~::i:.. ~:~ I PERMIT NO. 0(. (1?U J
3. Yellow AppliClllt ~ /<<C1
ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID c j--' ? ftL~ . 0, 1. 0
OWNER
(Name)
:::- j-cMJ ! 4/ rh./"/'~ '_ S:~-5'or1
(Phone)
(Address) ItfS-6Y ~(f)fe /Pl~4€.7la91(< A/'L f)'lr kLP" MA/
, ,
~~~~~ANT ~ )6d_A7~ :;;J c .
(Phone)
S7T1- 663 ) 206
(Address) 607 SJ7T/iT"f:/\'/) W AJ
(Address)
J17M~
(City)
550) ~
(Zip Code)
(Contact Person) ;J;kllt CAc..~ (Phone)
APPLICANT SIGNATURE ~~t:--e~ DATE
. - - .-
(/ APPLICANT ~ASE COMPLETE BELOW
[]NEw CONS~UCTION D REPLACEMENT Jl'AL TERA TIONS .'
FURNACE MAKE AND MODEL ILl) N .-*'''' rl.J;./W~ h/41/'tA-cJ. FUEL.AJ, (:)
FLUE SIZE '-Iii RETURN OPENINGS ,..J / A- INPUT 3~J VU' oN OUTPUT
lYPE OF SYSTEM HEATING OR POWER PLANT
~VI-~0 3, /ZC;()
:>~ 2 ~;-"b
OWann Air Plants
OGravity
o Mechanical
OAir 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
-'
Industrial. Commercial & Multi-Family
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Residential. Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $ 39,.) V Building Permit #
HEATING PERMIT FEE $ 39. ') V
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4V, cD
(Office Use Only)
This Application Becomes Your BuDding Permit When Approved
BlIIIdhaa 0ftIda1
Date
I Paid Itfo . ez)
Date r r
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R';[ei), o. 5/~2r
By' .
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245