HomeMy WebLinkAboutHeating & A/C Permit #12-249 � ❑�❑ � C� ❑�0�00 � O D ZA
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�INNESO'��` (�►1� `� �. P�� F�te PERMIT NO --
2. Green City �
3. Yellow Applicant � 1
lease or ' t and si n at bottom
ADDRESS ZONING (oflFice use)
3oq � l�o�ea.� "Tra.� I I��
LEGAL DESCRIPTION (of3�'ice use only)
LOT BLOCK ADDITION PID
OWNER ` ��� ' � �'
(Name) ���b r b� ` (Phone) 5 ���
(Address) �j � � YYii' {V � �"(` 1 O`�� � � s�J
APPLICANT p p ��— !!
(Name) ` d � � � � (Phone) �� �'�j'" � O J �`s�� `7
(Address) � ^ v � VC� N � c� � �L_ 6 n �s�
( d ess) (City) (Zip Code)
(Contact Person) 1� I 1/l,�-� (Phone) �1D3` ��J� r ��� /
APPLICANT SIGNATURE T DATE c.7 �"� �OZ
A PLICANT PLEASE COMPLETE BEL
�NEW CONSTRUCTION PLACEMENT ALTE
FURNACE MAKE AND MODEL L
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 into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System �ther Devices Cantilevers to the Outside of Buildings
� ��--p Require a Building Permit.
FIREPLACE MAKE AND MODEL �1LiXL
FEESCHEDULE
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 Conshuction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit # / �
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HEATING PERMIT FEE $ /. �� �
STATESURCHARGE $ •��
TOTAL PERMIT FEE $ , `
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid - �� Rec ' t No. ��3 �/'�
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Date f � � � ,
Buildin¢ Ofticial Date �
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372