HomeMy WebLinkAboutMechanical Permit #12-1375 � ❑ p� n 00�00❑ � O D ZA
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4 p Rip CITY OF PRIOR LAKE Date Rec'd
� � � HEATINGIAIR CONDITIONING/FIREPLACE PERMIT � � � � � �
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�I�'NES��� 1. Pink File PElll�'lIT NO./� �
2. Green City
3. Yellow Applicant i
Please or 'nt and si at bottom
ADDRESS ZONING (ott'ice use)
O � •2 I�. � �CaK
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER e r_
(Name) _ � � � _ N.1 S s�✓' o S ►'1 �!� � (Phone) �S� -�?00 � g �� �
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNA DATE — a o a
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
RNACE AND MODEL ��"G7E 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 Box Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
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
The Minnesota Statutes § 326B.148 �ost $ Building Permit #
"SURCHARGE" has been extended
until june 30, Z013, HEATING PERMIT FEE $ �✓�
The minimum surcharge for a STATE SURCHARGE $ �� �.5$
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ ,� , S�
il
This Application Becomes Your Building Permit When Approved Paid �� 5 --� R e pt No. ��� A
��,
Date ��, �� ��
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