HomeMy WebLinkAboutMechanical Permit #12-0871 S ❑❑� C� DOO�O❑ � O D Zc�
n n� y n (� � fA ?I Z'11 �I �I � � 0 ��
o 0 0 3 m ��oo z m �o �^G
b r ° m m 7�C m Z�sZpZ Z � y ��
� n n N Z � �1�� ,� � Z�
V � A y N � Z = O�
� � O � ^ O A �
� ' Z ,�' Z "� m
l� O� � Z �
� r o
,� � v
� Z 7�o A � 000000
o m z o v "'c �
"�C Z � �W�� m O r' n
� O � � A ��0��� � � 0
� m � �+
'�+ � � � �� � a . �
�' � � _ ��� Z �n
�" z , m ���o a o
� A �
= m
O
� y °< �000ao �
m �
� > � ��°�°a� �0 �
� � �55�� 1
� n �mm��
� ^+ � �+ z F �
�� �
-k- I'1 - �. � � ���� � ��y - �.:?
o � p RI CITY OF PRIOR LAKE Date Rec'd
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� �
�INNES�SP t. Pink File p
2 . ��, �, PERMIT NO. � Z—� D 7 I
3. Yellow Applicant
lease e or ' t and si at bottom
ADDRESS � � lJ �l' �� � � ! �I.�-�'1�.� S S I � � S � ZONING �ot��,�>
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWNER �� (C�:� I l� � (Phone) I J� l ` 1�� � — � �) � ) �
(Address)
APPLICANT c (� �l
(Name) 2" (Phone) J� � llJ� � �� �J�J
(Address) � �V � w 1 � J � � � l � ► " ! � ��
(Address) (City) (Zip Code)
(Contact Person) l� (Phone) 1 J� _� ��"
APPLICANT SIGNATURE ° DATE �
APPLICANT PL A COMPLETE BELOW
� �", ❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
F�E� MAKE AND MODEL I�O[� FUEL
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
� ir Conditioning ❑ Special Devices Fireplaces with Bog Additions or
ent. System ❑ Other Devices Cantffevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
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 , I�' ti ditions & Alterations �`=�
Residential, Heating Only (New Construction) $64.50 � Residential, AC On y 0
— � �ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $ `��
until ]une 30, 2013, STATE SURCHARGE $ �.Vd .
The minimum surcharge for a TOTAL PERMIT FEE $,_�jL�.���
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid �� ty► Receipt No. �
,,� v
Date D'/ � /�� By
Buildin¢ Ofticial Date 1S ���
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372