HomeMy WebLinkAboutHeating & A/C Permit #12-147 � p p� n O�OOOD � O D Zn
y n n O N?1='rtT�1 O � G y�
� c� � °°� 3 msc�co m r" m ��
��� 3 r 3z-a � tn .��
� � � m m N Rt N �zDZ p N p�
ae � . D� Z , 9 ' -� � Z �
1�0 � D fn N n Z Z Z �
� m � > � p � O�
� � A D Q m 7C
m
� O � Z �o
� r v �
� � v
� m � o o �l❑O❑❑❑
'�r k m m m m��'�
o� -� N o v �� - e
•e z �° �W�� m O c
� c�� � z�=o�� 3 Z m
� � � o �„8 0� -, � �
� -+ o z z�� z r
� z � m �'°� � v
� A � N �
� � � i
� y m ❑OO❑�O �C
Z z ���OZ' J "�
� O � r'mo��� m
D m v
� c �mm�� �
"C m �� r m
� �� �
I
pRx CITY OF PRIOR LAKE Date Rec'd
`��
�°� �' ��� FfEATINGIAIR CONDITIONING/FIREPLACE PERMIT
�. ��:;�
� ��
; � �;�, �; x
i V L�'. .� f � .
-71N 2. Green c�n, PERMIT NO . ,i - � i
� 3. Yellow Applicant �� / /
! (Please e or rint and si n at bottom �
ADDRESS ZONING ���a v�}
`-t S $ `�l t7�1:Q.r I o o �-- �,� � �
LEG.AL DESCRIPTION (ofFice use only)
LOT BLOCK ,ADUITION PID
� Elt � � 0 S �tl�, ` � (Phone) �,S 2 - `{`-t 0 - � 2 6 l ;
(Address) �5�b`'� �U `'Q,✓ � W � � � S �
��I�CANT 'P✓b t�l.�� ; *�� (Phone RSZ- �S- ���
(Address)�S�G �a.S�.� ��Q�S �� S.�`'�"�
ress) (Cityj {Zip Code)
(Contact Person) �/l�GLO� S� o'LqVtti C-�c_- (Phone)
APPLICANT SIGNATURE DATE � � 2
,
APPLIC T PLEASE COMPLETE BELOW
QNEW CONSTRUCTION �JREPLACEMENT ❑ ALTERATIONS •
FURNACE MAKE AND MOD�L _� -� 3(Sf�'v �bC��7 U FUEL ,P�ctS
FLUE SIZE RETURN OPENINGS INPUT 7U, vG6 OUTPUT S O b
TYl'E OF SYSTEM HEATING OR POWER PLANT .
❑warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
I�Gravity ❑ Hot Water into Reqaired Side Yard Setbacks.
C�Mechanical ❑ Radiation
�Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
�Vent. System ❑ Other Devices C�ntilevers to the Outside of Buildings
Require a Building Permit.
FTREPLACE MAKE AND MQDEL
FEE SCHEDULE
Industrial, Comtnerciai & Multi-Family 1% of,job cost Residential, Gas Fireplacc $49.50 '
$49.SQ minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construc[ion) $64.50 Residential, AC Only $49.50
Fstimated Cost $ $`� $ � • o � Building Permit #
'['3ie Minnesot� St�iutes § 32613.I�K
HEATING PERMIT FEE $ �q S v '�S�RC:I-IARGF.;" hws been chun�ed I'or ane
year effective
STATE SURCHARGE $ s• ov -5A- ���iy �, z��to, �r�f�3 �«n� 3�►, zai �.
TOTAL PERMIT FEE $ Sy • O p Thr minimum surcharge for a "fisecl fec" permit
(Office Use Only) is �+, be};inning .I�EIy 1.201U
This Application Becomes Your Building Permit When Approved Paid ��� � Recei t o. j S- A/
I� `
�ate 3 Co . / � �Y
BalldiaE Official Date .
24 hour notice for all inspections (952) 447-9850, fax {952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minucsota 55372