HomeMy WebLinkAboutMechanical Permit #12-1276 � ❑ O C� 000�00 = O o =c�
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� rRi CITY QF PRIOR LAKE Date Rec'd
,�°��� � � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�',NNESO��' 1. Pink F,�� PERMIT NO. �'Z— /Z]6
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1. vd�uw apy�ioent
Please e or ' t and si n at bottom
AnnxESS zo�vstG co�a ��,
5"o b`�1 'Po� cl S-e d�e.. `-w- �
LEGAL DESCRIPTION (oH('ice use only)
LOT BLOCK ADDITION PID
OWIVER , �
(Name) �'P� 1✓1 �0�✓�- (Phone) �O� �Z g�s 3Z 2 Z
caaa�ss� 5b� `� ��. 2(� �e... C.r�._. ►-�o � (c� SS� 1 Z
APPLICANT �Q A
(Name) + Vl_ � !`t��— (Phone) � S Z ' �� S : �1 � 7
(Address) � vV�" �S Iv`�v S��`�
(Address) (City) (Zip Code)
{Contact Person) w4�� 1�-q �Ul, � (Phone) �SZ � —�
APPLICANT SIGNATURE �T/ DATE � °' (, �
APPLI ANT PLE E COMPLETE BELOW ,
�NEW CONSTRUCTION REPLACEMENT ❑ ALTERAT[ONS �
FURNACE MAKE AND MODEG 1�✓H�✓I,T � S�1 �. 6 � n� b FUEL C aS
FL,UE SIZE RETURN OPENINGS INPUT �U � OUTPUT ��c 6od
TYPE OF SYSTEM HEATING OR POWER PLANT ,
PLEASE NOTE: Air Conditioner
�Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
� Crravity ❑ Iiot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation
`�CJAir Conditioning ❑ Special Devices �eplaces wifh Boa Addifione or
❑Vent. Syst�n ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Buildfng Permit.
FIREPI.,ACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Mu1ti-Family l% of job cost Residential, Gas Fireplace $Q9.50 '
$49.SQ 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 #
The Minnesata Statiites ,��' 326Q.1�18
� c� S� "SI.JRC:IiARGF.;" h�s been cht�n�!ccf I'or one
HEATING PERM�T' FBE $ ye�r effcctive
STATE SURCHARGE $ .50 .�,���� �, 2t� t� unfi! Juqc 3f) zui t.
TOTAL PERMIT' FEE s �. Sp T6c minimu�n surch�rtie I'or a "�i�e�l fcc" permit
(O�ce Use Only)
is ��, br„innin�.luty 1.201U
This Application Becomes Your Building Permit When Approved Paid ��/. �l Receipt No.
�,�. �� v
Bpildine Official Date Date / D �, j/ Z By �—
f--G1 ��-�,��
24 hour notice for all inspections (952) 447-9850, fax {952) 447-4245
4646 D�kota Street S.E., Prior Lake, Minnesote 55372