HomeMy WebLinkAboutHeating Permit 11-1269 - 0 0X 0 000000 - 0 0 > E
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(Cr RI( � CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT 1,. z/ //
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.titz:vivEsoy 1. Pink File City pERMIT NO .
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2. Green NO.// / /0 7
3. Green Applicant ` iii z_
(Please type or print and sign at bottom)
ADDRESS i �� ` V , � , i I +-' ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) A it � l Y 1 44... (Phone) (O WI U —1 1711
(Address) WE i W/
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) y� / (Phone)
APPLICANT SIGNATURE ` V DATE it q ( 1
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
❑Warn Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
DAir Conditioning ❑ Special Devices Fireplaces with Box Additions or
EVent. System ❑Other Devices Cantilevers to the Outside of Buildings
F- Require a Building Permit.
*1:1ZEItiOigE"Ictik GI N �6 { l Uf l
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
r_` -- ' Cost $ Building i'ermit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended y �
until June 30, 2013, HEATING PERMIT FEE $ jJ50
The minimum surcharge for a STATE SURCHARGE $ 5 Cf?5
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ ,..55 - CO
This Application Becomes Your Building Permit When Approved Paid sz) Recei o.6 4Lj (�/
Date 2 /_,/ B s
Building Official Date `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372