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CITY OF PRIOR LAKE
16200 Eagle C....k Av. S.E. Pennh No.
Prior Lake, MN 55372
HEATING APPUCATlON I PERMIT
Date 't .<::::: - />l-IJD PID. .QS"- 31 .-
Site Address Y'1o _<\ ~ ./Jd.. f" K wtJod). Or ~. or.
Lot ~ Block 4 Addhion--11 )cmd. r\d~, C5.J1A.~
OwnefsName $ho.l'\Je. (f)jc.'T'Z:..11-~79aflC;--.<;~
Z'6 5'"6, P6.~Kwo~& D t" 5. ~
Heating Contractor Pr-\ bt" L....Ye. J.I-I...o... *-J'J J~
Address / t.. t::;'>? Y ~.IdJ/t:::1f rt!)t!)R t!.t-
Address
I 81epnone If
",_-.. "1-/1-'
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<"IliA
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Furnace Make & Model
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Condhioning ./ ~..;> 7ru.J
Vent. System.
Model Size
Conn. Load
-
-
Fuel
Flue Size
Supply Openings
Return Openings
Input
Edr.
HEATlNGORPOW 01031200\ uE 10
Steam \ Sf,D D
Hot Water C,--O 1\'ln'i
Radiation \~J'>.C
Special Devices _
Output
Other Devices
C1m.
TYPE OF WORK
Alterations
v
New Construction
Replacement
Repair Est. Comp. Date
Est.Cost$_J.5'SD~ BuildingPermh' ('rh .^3S<c5)
HEATING PERMIT FEE $ :3q, sn
STATE SURCHARGE
TOTAL PERMIT FEES
$ .50
$ '16.00
Receipt. 3 7/..fJJ:f
TYPE OF STRUCTURE
I. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family
Commercial
~
Muhi-Family
Other
Two-Family
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Reaidential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Addhions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minim"um)
$99.50
$64.50 MAY 2 2 2000
$39.50
$39.50
$39.50
Remember to add the State Surcharae on the bottom of this aoolication.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
Houppl'
Record must be submitted with puildino wmil number before build-
upancy will be issued.
is. REQUIRED wilh number of supply and return openings listed per
'pening. New structures or additions send floor plan wilh supply
'own. HEAT LOSS CALCULATIONS, PAYMENT AND
...~, BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
_" "vE. 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
447-4230
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; that the work will be in accordance with the approved plan in the
case ?:7=~ew and approval of PI~_ / g-a;
Applicant's Sjjjmlfure . Dj
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