HomeMy WebLinkAboutHeating Permit 12-0080 5 ❑ - (7 0000❑ = 0 > Z c)
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p CITY OF PRIOR LAKE Date Recd
°. �-R194. _.� HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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�'NNESO�cP ,. Pink File PERMIT NO /2, /)
een 3 Ye 2. Ye City �/ . llow Applicant ��V //
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
./s 3 4do
Pd Dabs Road S '6-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /J /�
(Name) /�f C� GG 4 ? & (Phone) 6 1 394- OS96
(Address) ✓S 6 ' gG1 O.�iC /1 oa,1 sc' ) P.-,` B f' 4 4,frr ` A) - 5 .5372
APPLICANT /� � ,5Cra s
(Name) 4 GtGL �, ' �fj J e 4 'tL t,4iie (Phone)
(Address) 9 / /// t� Gar A A-ko s3
(Address) (City) (Zip Code)
(Contact Person) ' • ► Q C 24 c-- (Phone) 9 — ya3 "" //iv
APPLICANT SIGNATURE - --) DATE c2/9/,/ Z
APPLICANT PLEASE OMPLETE BELOW
❑NEW CONSTRUCTION EPLACEMENT El ALTERATIONS 1
FURNACE MAKE AND MODEL ...../79 7> 7 V A o t o FUEL la., r
FLUE SIZE RETURN OPENINGS INPUT 6 e 000 B O OUTPU sr J do'j>
TYPE O YSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravit ['Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System D 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 $ VV s'D. Da Building Permit #
HEATING PERMIT FEE $ y9,‘.17)
STATE SURCHARGE $ X AD
TOTAL PERMIT FEE $ ` TV- .Sb
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5 - 0 Rec No f ? v
Date " y ./ Z By �Y!
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372