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CITY OF PRIOR LAKE MC. 0
16200 Eagle Creek Av. S.E. Permit No. Q.
Prior Lake, MN 55372
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TYPE OF STRUCTURE
1. Pink
2. Gn:en
3. Yellow
File
City
Contractor
Single Family
Commercial
y
Two-Family
Industrial
Public
Multi-Family
Other
Date
Fee Schedule
Lot _ Block Add~ion .
Owne(sName adA."/ ~#/.>/~
Address /7'/h"C. #Sp?,6..A/ .#vL /P'L
HeatingContractor PdA':;b;K~U -//t##&M54>-~~~
Address / L?@ -uJ.t5;L A?cM.7 ~v ~#'A //k .ff4"fY
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Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
$64.50 PLEASE NOTE:
$39.50 Air Conditioner Units Cannot
$39.50 Encroach Into Required Side-
$39.50 Yard Setback.
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lelepnonew ll' J.- J 7....-?1 / ~J / i77
Remember to add the State Surcharae on the bottom of this application.
Fuel
Flue Size
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Cond~ioning
Vent. System
Furnace Make & Model
_....... LltI'vIC8S
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submitted with buildinq ~ number before build-
ing certificate of occupancy will be issued.
HEAT CALCULATIONS RFOUIRFD w~b number of supply and return openings listed per
room with CFM's per opening. New structures or add~ions send floor plan w~b supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
Model Size
Conn. Load
Supply Openings
WF=A"U"" -- --"
Input
Edr.
Output
CLOSED DUE TO
INACTIVITY 1/1/03
Return Openings
Cfm.
TYPE OF WORK
3i6(geJq
. I~SLu.;~{.{. _~~;ildi/ical's Signature
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL;jbat-tI1eWJ>rk will be in accordance with the approved plan in the
case ov.rtf work wAi'Ch.tequirE}ll/7eview and approval of plans.
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/ Dafe
II.Uf. oiJ
Date
re
A~erations
'X
Replacement
New Construction
,
Repair
Est. Comp. Date
u0S2-
/ ~ /. Building Perm~ #
pc.-
HEATING PERMIT FEE $ ..<./tJ -
STATE SURCHARGE $ .50
TOTAL PERMIT FEES $ ~/l.7tf) Receipl#
~/f/ j(/' c,;//.t.n.. k #/?yut
Est. Cost $