HomeMy WebLinkAboutHeating Permit 11-0707 VOIDED (jRi
CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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4 j ¢ 1. Pink File
JNxESO 2. Green city PERMIT NO. 1/ _ 747
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ( 63V ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (� C' p S 1
( Name) ?icL p ( ,4) 44_- (Phone) L — i S� J
(Address) V 3 /7 c- d 'it 6j ( '9 l Li 7 C
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APPLICANT 5' YO IDED
(Name) p ttr s i DIM
(Address) 1C,
(Address) • I� • 1 1 (C>ty����� ci `
(Contact Person) (Phone)
APPLICANT SIGNATURE ' / I I,► ° 4 DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
D 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 Fo ros C antilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL E7lc.0'1 /44.66- To BerAcw
p ic6 77k use- - &is G A-0-s wtw ju �d-z, A-r- 1M a&
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 $ 49
STATE SURCHARGE $ .59 O
TOTAL PERMIT FEE $ 9
(Office Use 0 , ly)
This A - 1 n , o I es You : • . ing Perm' W n Approved Paid , �� Receipt No4 xg
�I / 4-/fl Date B ph (A.,
Buildine Office Da ���
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRI
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441/414 EsdS II
MEMORANDUM
DATE: Friday, September 23, 2011
TO: Janet Ringberg
FROM: Lynda Allen
RE: Mechanical Permit #11 -0707
16316 Park Avenue
The applicant on the above referenced permit has opted not to do the work. Please refund
half of the mechanical permit fee ($24.75) to:
Rich Powers
16316 Park Avenue
Prior Lake, Minnesota 55372
Thank yo
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1 d...'e'en
Building ervices Assistant