HomeMy WebLinkAboutHeating & A/C Permit #12-535 � O❑ n OOOOO❑ _ � o Zn
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o � pRlp� CITY OF PRIOR LAKE Date Rec'd
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT � S � ��
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� '. P ``� F11 PERMIT NO.
2. Green City / �,..� � j
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS ZONING (ofl�ice use)
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LEGAL DESCRIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID
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(Address) � � �'` Y �� �{ Q � �
APPLICANT ���� �') " 1 S� ��� LI 1' 1� 10� '1
(Name) �n �- (Phone)
(Address) � ��� "� W �. S�� V1�I `' (` � � ^� \�.l S S 3 � �l
(Address) (City) (Zip Code)
(Contact Person) � l � L' �. (Phone) q S � � -� � 7 • a � ��
APPLICANT SIGNATURE DATE �9 ' "1 "" I �
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL �+� c-,�.T � a� A� aa �� �"� FUEL �� 1
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
�,Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water
❑ Mechanical (�,/�\I c, � ❑ Radiation into Required Side Yard Setbacks.
�Air Conditionin J Fireplaces with Bog Additions or
g N� aa� ❑ Special Devices
❑Vent. System )�-� � ❑ 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 $ Building Permit #
HEATING PERMIT FEE $ � � - � J
STATE SURCHARGE $ �JO
TOTAL PERMIT FEE $ , .,�U
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ,/ f --U Rec ' t No. /- � G �
�,� lQ
Date� ' � � �_ B `
Builaine official Date `
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372