HomeMy WebLinkAboutMechanical Permit #12-1087 5 O❑ C) ❑00�00 � O D yA
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�� p RIO�� CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
N �
� x
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�In'NES��� 1. Pink File
2. Green City PERMIT NO . /� �/ D� J
3. Yellow Applicant
lease or ' t and si n at bottom
ADDRESS ZONING (ott'ice use)
� W I S I . 1/l„J •
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ' I n ,,d/,,
(Name) � (Phone) �' 7��~ J�Y 6 W
(Address)
APPLICANT p,��yeiance C�nnections Inc
(Name) (Phone)
Y �.
(Address)
^ (Ad �45-4803 (City) (Zip Code)
(Contact Person (Phone) vl V
APPLICANT SIGNATURE , DATE �
APPLICANT PLEASE 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
❑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 ❑ 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 $ T/' J"
STATE SURCHARGE $ .�"sC�
TOTAL PERMIT FEE $
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid � �� Receipt N. D
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Buildine Official Date Date �// ��_ By � �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372