HomeMy WebLinkAboutBldg Permit 09-0021 Mech Fireplace
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CITY OF PRIOR LAKE
H:EATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
/. /3. OJ
~. ~~=w El~iCOJlt I PERMIT NO.oq, 002 / I
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i),Ff'\ Av~ s L0
ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Phone) lJ n.., - 2 ~ ".. ~l 'j \
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(Address) \~J 1- "
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APPLICANT F l n ::;, :'\ S
(Name) ~t::. v' vl.::
l~f\ tl- i\1
~ Hp~c. (Phone) ~-)I- (P33-/O~2-
~)6V\Ll~ ~,J $1/3
(Address)
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f'A 1 A-v I L~ /tJ~ jJ (
(Contact Person)
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(City)
(Phone)
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APPLICANT SIGNATURE
DATE
i\.PPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION o REPLACEMENT o ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants o Steam PLEASE NOTE:
DGravity o Hot Water Air Conditioner Units
o Me,;hanical o Radiation Cannot Encroach into
DAir Conditioning o Special Devices Required Side Yard
DVenlt. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL ;felt J-.N - flu f6-&f)M) I
l../~ vJ) i)j\J)
.
Residential, Heating & AlC (New Construction)
Residential, Heating Only (Nc:w 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 $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
(Office Use Only)
Buildin2 Omcial
Date
Paid 57J. (fV
Date I. IJ: ()
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245