HomeMy WebLinkAboutHeating & A/C Permit #12-250 y O❑,� n ❑❑000❑ = O o Nc?
� � �� O �n�Z�,,,�, p o �
n �� o 0 0 3�zu,�°c° m ^' m �O
b � �' m m� ITi z z � t ��
� �
t�? � � � � - m � � ={ O Z -
�O � n� N � Z Z ��
� � � o c �` o ��
° z � l x R+ m
�
0
� o D z � �.
r
_ � � �v � �
� Z � � n � �O�OO❑ , A r
�' m m m m ��vu,g�v v"
O� - y O O � �� nC „D �nC V
� x3r1r mx$ � c� ( �,� cn
� C � � - n i ��+ z 3 z Uv rt
�° cmi cj o � r� � � � C
� � o z . 7C 7C
O = � � ��� O �
� A � �
= m �i
� c � `b
y m � ❑❑❑�O❑ (� ,,
� Z � ��t�1n ` "�- >
A• D Gf ymm3� 1
� rv�v ("J
� � 1
� n Dmm�� fy
m �T� r v -+
~ yZ � . m
-� r �A
!
� p R fo CITY OF PRIOR LAKE Date Rec'd
�° f„ HEATING/AIR CONDITIONING/FIREPLACE PERMIT
�� �
"v`_��'M
' �f�'NESO�P ,. `';"� F�'` PERMIT NO. /Z Z...�
�, 2. Green Ci4y `
3. Ye31ow• Applicant
I —
Please ry e or rint and si n at bottom
ADDRESS ZONING (otr�� �5e)
�L� �, v �►- \
LEGAL DESCRTPTI4N (oPFice use only)
L�T BLOCK ADDITION PID
OWNER�
(Name) � � P iA v Q ��' �.v � ` (Phone)
(Address} � � `�� ; u,� I�IrJ —_ --
API.'LICANT
(Name) � (Phane) ��Z`c r '�J�-���o
(Address) � L-..��� ���h� (l� i 1I � �t� /r.lf�• 4 ____ ��"-�� �
(Address) (City) �— (Zip Code)
(Contact Person) `� � (Phone) ��Z"�"�(� "��y k�� '
APPLICANT SIGNATURE DATE � ,��G' `�
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS �
FURNACE MAKE AND MODEL `�Yl�(�,11C ��0� � l� ���r� �lo� FUEL ��y , J�
PI.UE SIZE RETURN (?PENINGS INPU'T � TUV V OUTPUT �
TYPE O�' SYSTEM HEATING OR POWER PLANT �
PLEASE NOTE: Air Conditioner
QWarm tlir 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 bevices
❑Vent. System ❑ Other Devices Canfilevers to the Ontside of Buildings
Require a Bailding 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 On1y (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
'T'he IVtinnesc�ta St�ittrtes ,��' 32Gf3.148
"Sl.if2C:11ARG[;�° iris licen chr�ngcd li�rone
HEATING PERMIT FEE $ vcar eff'cctive
STATE SURCHARGE $ .50 .9�d� t. 24�i(s, ui�ti:.leanc 3t). 2t►11.
TOTAL PERMTT FEE $ Thr minitnnm sw•ch�ry;c for a "Csed Tcc" permit
(Office Use Only) is „'ti'��, lic�inning ,)nly 1. 2U111
This Application Becomes Your Building Permit When Approved Paid �-i L� Re pt No. � S 3��
�
Date �� �� `
Buildine Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 4A7-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372