HomeMy WebLinkAboutHeating Permit 11-1144 J
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0 . r it/ CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
4 iiivNESDY
i P ride I P ERMIT N
Gr Ye c,ry eant / O. // 4
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(Please type or print and sign at bottom) . ll ow wp
ADDRESS
r cn { ��C' 051 94/ frir ZONING (office use)
3
9
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER W Q/ } PID
9111 WI /� (Phone) V , /5 P f O5
(Address) I ?NV/ e 0 sw Y lare 5
APPLIC jo C me 1 11 1 OIi P / (�' hone) 1-41-4 (Name) I. (Address) t 10 [i(.� t\ Yllf(f hotO
(Address)
(Ci ) Zip /ode)
(Contact Person) `" 1 � , �,�
(Phone) - 5
APPLICANT SIGNATURE
i lOtsdiaL DATE 10 — 1D • I I
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL O (' l e■(
` FUEL NO
FLUE SIZE RETURN OPENINGS 1( ,00C) INPUT OUTPUT 5(
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants 0 Steam
Units and Fireplaces Cannot Encroach
❑Gravity
0 Hot Water
into Required Side Yard Setbacks.
❑ Mechanical 0 Radiation
Air Conditioning ❑Special Devices Fireplaces with Box Additions or
Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL Require a Building Permit.
FEE SCHEDULE
Industrial, Commercial & Multi-Famil
Y 1% of job cost Residential, Gas Fireplace $49.50
Residential, Heatin & A/C $49.50 minimum
g (New Construction) $149.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64.50 $49.50
Residential, AC Only $49.50
The Minnesota Statutes § 32 6B.148 lost $ Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, HEATING PERMIT FEE $ - I . 61)
The minimum surcharge for a ;TATE SURCHARGE
"fixed fee" permit is $5.00 $ 50
COTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid s ✓
L� Rec 1j', t No. ` ��
Building Official Date `�� ^ / / /
Date L4
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 /
4646 Dakota Street S.E., Prior Lake, Minnesota 55372