HomeMy WebLinkAboutHeating & A/C Permit #12-0801 ; ❑ ❑� c� a0000❑ � o > y�
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�, HEATING/AII2 CONDITIONINGIFIREPLACE PERMIT
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� � z: �'� c��r PERMIT NO. f �_�Q� j2
i l. Ydlow Apptic�m
CdSt t O[ � t BYId Si �St Tfottom .
� ADDRESS ' Z N G(office use}
; 17 2 �3 V� Ocxl,� �e�n1 �# . :
� LEGAL DESCRIPTIUN (ot�'ioe use onty) ,
LOT BLOCK ADDI'ITON PID
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(Na�me) V t � � '� �@ � e;ISo � (Phone) q5 2 - 2Z(� - 215 D '�
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(Address} i 7 223 1Nopc� U i e1�J C� . .
APPLI c--��tv ; �-r ���`� ������ '
(Name) U 16'8'In�A,Y�tT�vl rtCa�u�d ��� Y Q (p� � S 2-$�t �f - ,�5 5 Z
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(Ad�ress) b+�0 iAl. �2`"�5�, 1B( ` a3�120 �
(Address) • (CitY1 (ZiP code)
(Contact Person) ��-�- 11� e,u� Q�d (Phone) Gl 5 2-� g y S S 2.
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APPLIC'ANT SIGNATURE DATE (n - I 7' I 2
,
APPLICANT PLEASE COMPLETE BELOW ;
[]NBW CONSTRUCTION (�REPLACEMENT ❑ ALTERATIONS -
FURNACE MAKE AND iGfODEL FUEL �
FLUE SIZE RETURN OPENINGS INPUT OUTPUT .
TYPE OF SYSTEM HEATING OR POVVER PLANT
Owarm Air Plants ❑ gt� p��E NOTE: Air Conditioner �
Units aad Fireplaces Cannot Encroach
OCrravlty ❑ Hot Water �� g Side Yard 5etbacks.
���� �� �re laces w3th Boz Additiona or
Air Conditioning ❑ Special beviCes p
ent 3ystem [� p��. �,i� Cani3levers to the Oatside of Buildings '�
Require a Building Permit
FIREPLACE MAKE AND MODEL
' FEE SCH�DULE
industrial, Commercial & Multi-Family I% of job coat Rasidential, Gss Fireple�ce � 549.50 •
549.50 murimum
Residential, Hesting &_A/C (New Constructian) 5149.50 Residentisl, Additions & Alterations 549.50
Residential, Fieatin�g Only (New Conatruction) 564.50 Itesidential, AC On1Y $49.50
Estimated Cost $ Z 0. _ Building Permit # �
The Minnesota Statutes � 326[3.148
HEATING PERMIT FEE $ �Q �S�? " S�RCHARGE" hac been changrd for one
year effcctiv�
STATE SURCHARGE $ OO, Jul�� I, ZUlti, u�iti! Juqc 3U, 2U11.
TUTAL PERMiT FEE $ 'J`�" .'rj� T6c miplmum surchar&e for a"fisccl fce" permit
(Of�ice Use Only) _ is.��',,i, b��inning.iuty 1.2010
This Application Becomes Your Bailding Permit WhedApproved Paid /" t- /} Receipt No. � 3- �?
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guiw�e or��wi n.r�
24 hoer notice for atl iaspectlons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street 3.E., Prior L�ke, Minnesota 55372 �
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