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Heating Permit 08-1012
— 0 O 0 0 0=00 v 0 > 20 \ §§§ 3 2 > c c 0 m ,, m o \ r, q 7 7 I -� § U z $ -� % It m m \ q ) -..1 G.) P �k Z 0 ° �§ q 73 $ �� /§ ■ mm ) 2 E o 3 N I - - a - 0 § Z 2 0 0 000000 § §)\ ' -U-U 2 ...1 g0Q & -I qE . ) § K i m �2§77xi§ m q �� 0 11 m§ § " > 0 3 2 / q _ § 0 r2// . _ C / 0 m ,_ _. „ �� m X m _� \ I O < 000000 _ m z $]202 R. o ® � o p\ i f\mo§� c j - -r / k -i r 0 4 , K YRi )v RCITY OF PRIOR LAKE Date Rec'd HE ATING /AIR CONDITIONING/FIREPLACE PERMIT in AN P Y i ron k en City File PERMIT NO. (I / O 4 3 ' 3 Yellow Applicant - (Please type or print and sign at bottom) ADDRESS ZONING (office use) / (0 ; t() LOA) R 4/11° LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER A— 0 r ( '� G tr fi /' 5 � " — cl ! ©3 —/ 79_3 (Name) U It (Phone) ?S (Address) / — l4V .4 / _`' fez,,, ,4 uJ /V' rt-7 1V �l/ APPLICANT y- / / /� �> (Name) SO Gti/ A ./d F,, I/e-Rirl it t f (.m (Phone) qS �' d fv a2'vs� (Address) /1, WO /1 i"/f 0_144 ni`� 81 VcJ- 1�1 /ri L'� i1 %A l ?''- An. �' 7 (Address) (Cit (Zip Code) (Contact Person) R J -r�G R 5; Fe-14 (Phone) ?S VVV _� - 7$v- A-y� APPLICANT SIGNATURE /6 DATE /A -- — 68' APPLICANT PLEASE COMPLETE BELOW EINEW CONSTRUCTION REE. M ALTERATIONS FURNACE MAKE AND MODEL La/• - /e_t-- . mite _ / f--/-,?o FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT DWarm Air Plants ❑ Steam PLEASE NOTE: Gity ❑ Hot Water Air Conditioner Units Mechanical rav o ' ��'" Di Radiation Cannot Encroach into Air Conditioning /ate o 0 Special Devices Required Side Yard DVent. System 0 Other Devices Setbacks FIREPLACE MAKE AND MODEL ` FEE SCHEDULE ( 7 0' ,51) Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace 0 $39.50 minimum y.J,$7J Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations .$7'9.39 Residential, Heating Only (New Construction) $64.50 Residential, AC Only $39.50 Estimated Cost $ /.S, 50 ;Leo Building Permit # HEATING PERMIT FEE $ // 9. 3-0 STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ .517 - (Office Use Only) This Application Becomes Your Building Permit When Approved Paid so (f Re ipt No. S 1 1 f Date & c eY Building Official Date 1 Z. , (( ,U 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245