HomeMy WebLinkAboutH & Air Permit 07-649
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIy{€flLB 'LACE PERMIT
CLOSE 1; ACrlY1'0"
DUB TO 11""
2/10/2009
Date Rec'd
. ~~:y I PERMIT NO. 01 o(P4-Q I
w Applicant . I .
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z.. <).". 2.& I . CO L 0
I OWNER
I (Name)
: (Addres~)
~~
u~ ~\)L("
(Phone) LP l&-R\)\- \1:11.0 C~
APPLICANT SIGNATURE
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~0~'A~ -\\-.P0b~ ~ N.~f:-eruCL ~'I06\-'""1~4'O-lll{O
0-0.tV\&C\P'y\,.~ ~ ffi" 5i$~()2-
(Address) f, City) (Zip Code)
< ~U~ (Phone) \06\- 1.--:t-'6- )~40
DATE '-1\n\~
\U,-~L-D
APPLCANT i\
(Name) ~~,
(Addre~s)
'dJS
(Contact Person)
APPLICANT PLEASE COMPLETE BELOW
ONE'\' CONSTRUCTION ,REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
REA TING OR POWER PLANT
DWann Air Plants
DGravity
o Mechanical
&lAir Conditioning
DVent. System
~ .t) '"iOl\
\~ ssu<
o Steam
o Hot 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
Residential, Heating & AlC (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 #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3C1.SD
Buildin2 Official
Date
Paid ~() . 0 0
Date 7 Z 4 . c; 7
o. 51'2.4-
is Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245