HomeMy WebLinkAboutHeating & A/C Permit #12-420 � ❑❑� C) O�O�O❑ � O D Zc�
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��x� CITY OF PRIOR LAKE Date Rec'd
� �� HEATING�IAIR CONDITIONING/FIREPLACE PERMIT ,` j_/ 5. i Z,
v r�
�jNNES�' ' �'"� F '�° PERMIT NO. �
2 �, �,n /Z , �Z � �
3 Yellvw Apphcent
ease or 'nt and s at bottom
ADDRESS ZONING cotFia use)
� tn 0 u� � �
LEGAL DESCRII'TION (office use anly)
LUT BLOCK ADDTTION PID
OWNER
(Name) _� n� C� u►� r�e _ d (Phone)
(Address)
(Name 1-� f f t C. ' S � �11 '� I��,�]�� (Phone) 9 � c� � "y _ � ��� �
(Address) C�l) � 9 9�d L�l) � �� � . L r( (�-.� v c d � � � � � ��
( ) (���v) (Z+P �)
(ContacE Person) _ � `� hl�..,l (Phone) � 5,t� ' 3y � -� � ��
APPLICANT SiGNATURE DATE
APPLYCANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION � REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL �J� ` ��I� n��J' C Q� rl '� FUEL G d S
FLUE SiZE RETURN OPEI+IINGS INPUT �``I �,-� �O[7 C� OUTPUT ��
TYPB OF 3YSTEM HEATING OR POWER PLANT
�Wasm Air Plants ❑ S� PGEASE NOTE: Air Conditioner
���� Units and Firepl�cces Canaot Bncroacb
❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanicai ❑��a�� I�tireptace8 wjth Bo= Additions or
DAir Conditioning ❑ Special D�.wices
[�V�nt. System [� qt� p�;� Cantllevera to the Outside of Btiildinge
Require a Buildiag Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commerciel & Multi-Pamiky 1°/. of job cost Residential, C?as Pireplace 549.50
S49.50 minimum
Resid�ti8l, Heatiag dt A!C (New Construction) 5149.50 Rosidential, Additions 8t Altera6ons 549.50
Residential, Heating Onty (New Construction) 564.50 Residenaal, AC Only 549.50
r_�__._� Cost$ _ N�C��„'Z +� � Building Percnit #
The Minnesota Statutes � 326B.148
" SURCHA,RGE" has bee�� changed for one HEATIIVG PERMIT FEE $ ���
year effective STATE SURCHARGE $ S. U�
July 1. 2010, untii June 30. ZOt 1. TOTAL PERMIT FEE $ J�y. s�
The minimum surcNarge for a"tixed Pce" permit
is �,,5., begioning duly i, 2019 ,_
This Application Becomes Your Bnildiog Permit When Apprnved Paid�-� s � Rece' No. �����
BefldinaOftidtl Date �� `S ` /S . /2 BY
24 hoar not[ce for all in�ectlona (952) 4d7-98S0, fa: (9S2) 447-4245
4646 Dskots Street S.E., Prior L.41ce, Mianesota 55372