HomeMy WebLinkAboutHeating Permit 11-0355 DX 2 0 00000 71 0 > E
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,v.--11' I CITY OF PRIOR LAKE Date Rec'd
A � HEATING /AIR CONDITIONING /FIREPLACE PERMIT
`iljNNES�'S¢' 1 File ��
z. c�Pink een city PERMIT NO. `/ 3 $
3. Yellow Applicant
(Please type or print and sign at bottom)
DRESS ZONING (office use)
(tL f S i , T e el WE (( ((;?:p
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 7 j J/�y� r , .d 1 T6 D
l ull � (Phone)
(Address) (/O 5t l ?� &ecKPTaI! WE Via( (i 377
1 ./, 17 i I , AP (N ame ) it 1 (4e hlr)i C 166 (Phone Tr i 9565
(Address 10 if e i) ,r (--At r f
Li( „� G (Address) ' .)) (Zip Code)
(Contact Person) (((//I+ (Phone -' �' �L[ ✓ ] % ✓ l / C 3
APPLICANT SIGNATURE r VNOW”' DATE 5-4-1 1
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION El REPLACEMENT R. 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
['Air Conditioning ❑ special Devices Fireplaces with Box Additions or
['Vent. System Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & 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 $ A • . •
STATE SURCHARGE $ .Old .543 -
TOTAL PERMIT FEE $ • .':111
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5, a) Re t No. (� / L ys ,
Date 0
Buildinu Official Date �� �/ •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372