HomeMy WebLinkAboutMechanical Permit #12-0888 ; ❑ ❑ � c� ❑00000 � o a Z�
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' � pRX CITY OF PRIOR LAKE Date Rec'd
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�, � � � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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� �l�'lVES��P �. r;�k F;t� PERMIT NO. j Z �� U l
2. Green City
� 3. Yeilow Applicant `
! Please ty e or rint and si n at bo[tom
ADDRE+SS Z�NIlVCi (office use)
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LEGAL DESCRIPTION (oHice use oniy)
LOT BLOCK ADDITION PID
OWNER � �DIo� ��
(Name) � l�7lNL J— v y���� �a � {Phone)
(Address} , �'{,3 `
APPLIC�T , � L �03 �g �� � 3� �i
(Name) � O�}-�1 ��j��- (Phane) .
(Address) `1_��7 � � II ���'�L,� N +eC�.� o mN .S $ yo��
(Address) (City) (Zip Code)
� �
(Contact Person) I (Phone) � �e � � �—$
APPLICANT SIGNATU r DATE '�f ��l �
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION f�] REPLACEMENT ❑ ALTERATIONS •
, FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
T'Yl'E OF SYSTEM HEATING OR POWER PLANT ,
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ' ❑ Hot Water
Mechanical into Required Side Yard Setbacks.
❑ Radiation Fire laces with Box Additions or
ir Conditioning ❑ Special Devices p
❑Vent. System ❑ OtherDevices Cantilevers to the Ontside of Buildings
Require a Bu3lding Permit.
PIREPLACE MAKE Al*(D MQDEL
FEE SCHEDULE
Indust�ial, Commercial & Multi-Family I% of job cost Residentiat, Gas Fireplace $44.50
$49.SU minimum
Residential, Heating & A/C (New Construction} $149.50 Residential, Additions & Alterations $49.50
Rcsidential, Heating Only (New Construction) $64.50 Residential, AC Only 4:5
Estimated Cost $ ��p� � Building Permit #
p � The Ivtinncsota 5t�tates � 3Zb[3.I�itt
HEATING PERM.IT FEE $ �(, s� '�S<<RC:IlARGf;" h�s been chaneed I'or one
Ye�r effrctiF•e
STATE SURCHARGE $ S :�ID Jnh� 1, 21l tU, imti! .le��tc 31), 21t I 1.
TOTAL PERMIT FEE $ , 4C��� The mi�dmmn surch��^�e fora "fi�eci fec" permit
(Office Use Only) is ti, befiinning.Rdy l, 2i1U1
This Application Becomes Your Building Permit WLen Approved Paid r � � Receipt N. /
V Q
Date � �//� By
Bufldin� Official Dete
24 hour notice for alt inspect�ons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minacsota 55372