HomeMy WebLinkAboutMechanical Permit #12-0921 N ❑ p� n O❑0000 = � p y�
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O 4 P Rip� CITY OF PRIOR LAKE Date Rec'd
� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� � $
� �t '�� 1. P�� File PERMIT NO.
C � 2. Green City / l �D A
3. Yellow Applicant � /
lease or 'nt and si at bottom
ADDRESS � �� ZONING (ot�ice use)
1 � c�� �' C�. 1. � �-
LEGAL DESCRIPTION (oflEce use only)
LOT BLOCK ADDITION PID
OWNER • ( ( ' t ^�
(Name) L 1r r , L � (Phone) "I �� a� `�� �" � � J
(Address) y �� LQ � 1 �� � 5� 3
� PLIj ANT � � � ) ��O�J " � ��C�7'"
ame � t �- Phone
.
(Address) -- ' '�l S 5�.
( d ess) (City) ip Code)
(Contact Person) - � In 1�—�'� (Phone) � �03�"� 0 �J " �
�
APPLICANT SIGNATURE DATE
LICANT PLEA E COMPLETE BELOW
�NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Wann Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
'� ir Conditioning ❑ Special Devices Fireplaces with Boz Additions or
Vent. System ❑ Other Devices Cantilevers 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 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only _ $49.50
�
�'°*;�°*°a rost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $ •:�.�/
until June 30, 2013, STATE SURCHARGE $ ��
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 5'Y�/, �(�
This App6cation Becomes Your Building Permit When Approved Paid �i/ 171 Receipt No. / J p
��Jlf (Ob d/
Date Q���� By
Buildine Official Date 0
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372