HomeMy WebLinkAboutHtg (Fireplace) Permit 09-0740 � P Rip CITY OF PRIOR LAKE Date Rec'd
� ee '� � � � HEATING/AIR CONDITIONING/FIREPLACE PERMIT �,l � ,� �
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3. Yellow Applicant
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ADDRESS ZONING (oflFi�e use)
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LEGAL DESCRiPTION (oflFice use oniy)
LOT BLOCK ADDITION PID
�aWNER �►�`.^, � < � �.. . �' C �"�� (Phone) �O � c�--.� Q I "5 ��
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(Address)
APPLICANT `
(Name) �'" � \��.. � �� 1 , rT�� � /� � �S �Phone) �v � c� �� � � — `( � � a, -
(Address) ��.� � 1 n. � Jac ✓ ��
(Address) (City) (Zip Code)
(Contact Person) � (Phone)
APPLICANT SIGNATURE DATE � — ( � — C��i
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑ Special Devices
Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings �
Require a Building Permit. _
FIREPLACE MAKE ND MODEL
FEESCHEDULE
Indus ria , Com Multi-Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, EIeating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ �1,3 v
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ �' O �j�
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid� � Rec t No��j� �
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Date/� / � J � y
BuildinQ Official Date 7 � [ -
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372