HomeMy WebLinkAboutHEATING 06-0380
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CITY OJ"' PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or print and si~n at bottom)
ADDRESS
1446\2 Gt~l--..i'A4.l~
~. ~i~:n ~~!~y I PERMIT NO. f)l__ 03F6
3. Ycllovv Applicant lO
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
.3(') e
I 44 ~ }
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G- \ P vdA "" ( -i
(Phone) q t;' 1. . 44 '1- 2XD Gl
(Address)
Q,-.A
~E
APPLICAl'jT,
(Name) UCt \, l eJ
(Address) 7 I , 2 S-
A,f'.( lAc-'
t.,..J I 1- G \- '""' S \-
(Phone) q 52. - ~ c)'4~() I
c;:... Ac J A(rC::- SS 3 ) '(
(Address) (City) (Zip Code)
(Contact Person) (\'\ ~ lL. J:} _ +\.{) tJ (\ rJ , (Phone) C1 (2:. <{'q() ~ A ~ \
APPLICANT SIGNATURE ~/};;;jf P ;/J DATE S- Ilt/ ()(;.
, / APPLICANT PLEA~ COMPLETE BELOW
DJ\EWfCONSTRUCTION l0' REPLACEMENT
FURNACE MAKE AND MODEL L '^'''l1 ':' r;; ~()/
FLUE SIZE RETURN OPENINGS
D ALTERATIONS
FUEL tJ A'\
_ INPUT ~. l') vV OUTPUT ~.f . "cJ..J
. .
HEATING OR POWER PLANT
TYPE OF SYSTEM
DWann Air Plants
D9ravity
[B"Mechanical
DAir Conditioning
DVent. System
o Steam
[B1lot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units 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
Industrial, Commercial & Muld-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39,50 minimum
$99,50 Residential, Additions & Alterations
$64,50 Residential, AC Only
$39,50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39,50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 39. S-l}
$ ,50
$ +0. ~o
. ~fice Use Only)
t~plication !ecomes Your Building Permit When .APproved
~ (-kdJ~ S-;/6/(?~
Buildinl! Official ' Date
Paid
40,00
sf, G,/ i)(,
I' .
Receipt No, r;/ LIt I
By ~ _ ~ ..
:>/,'
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372