HomeMy WebLinkAboutMechanical Permit #12-1010 � ❑ ❑� C) ❑ 0❑❑O � O D =c�
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o � p RI CITY OF PRIOR LAKE Date Rec'd
F � HEATING/AIR CONDITIONING/FIREPLACE PERMIT g,/ �
� x 7
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�7IN ]. Pink File PERMIT NO . / � ` /,
2. Green City / �J /
3. Yellow Applicant �
Please e or rint and si n at bottom
ADDRESS ZONING (oteice use)
C�' �' a �o,�c ��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER n ( 1�
(Name) �'�� �_ V�'U�tM C���� (Phone)
(Address) �' � �, �
APPLICANT, 1
(Name) '�'101�? c�.f� �C4:'��� �� (Phone) � � 0"' ��^ e l �' �,�-�
(Address) �.� � �O,f�Z.r,S�.+� ��11J�� c��a�U'�Q S��
(Address) (City) (Zip Code)
.
(Contact Person) �(' (Phone)
APPLICANT SIGNATURE DATE �
APPL T PLEAS OMPLETE BELOW
�NEW CONSTRUCTION LACEMENT ❑ ALTERATIONS
FURNACE MAKE D MODEL FUEL
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 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
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $ Q �
STATE SURCHARGE $ � .-
TOTAL PERMIT FEE $ S'
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid �L U Rece pt o. ��C�(t
�7
Date � � ! � By
Buildin¢ Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372