HomeMy WebLinkAboutMechanical Permit #12-1360 y � � �
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CITY OF PRIOR LAKE Date Rec'd
� D � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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l. Pink F��= pERMIT NO.
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3. Ydlow Applicent
Please e or rint and si at bottom
ADDRESS , � -� � � � ` � � � � / ZO1�iING (of�ice
` � �� � � �� .� i � use
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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(Address) ` J � � l�, �� � �� 1 "'` �V � �
Nazne) ANT L � n ` ` � l7L ��f �' N (Phone) �D J ` - l° � � � J 3� �
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(Address) Z �,� ��A �f��i� A��S �� ��5� ��t-1,�--� IM N�•� �,3
(Address) (City) (Zip Code)
(Contact Person) ��� � (Phone) � � � 33J�
APPLICANT SIGNATURE DATE b �
APPL CANT PLEAS COMPLETE BELOW
�NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants � g�� PLEASE NOTE:
����ty ❑ Hot Water Air Conditioner Units
❑ Mechanical ❑ Radiation Cannot Encroach into
DAir Conditioning ❑ Special Devices Required Side Yard
OVent. System ❑ Other Devices SetbaCks
FIREPLACE MAKE AND MODEL ����� � ���`' // �� l� � r f
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1%of job cost Residential, Gas Fireplace $39.50
$39.50 minimum
Residendal, Heating &c A/C (New Construction) $99.50 Residential, Additions & Alteradons $39.50
Residential, Heating Only (New Conshvction) $64.50 Residential, AC Only $39.50
Estimated Cost $ Building Per it #
HEATING PERMIT FEE $ ���- k�i- ?='
STATE SURCHARGE $ •SQ�'
TOTAL PERMIT FEE $ �i �
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This Application Becomes Your Building Permit When Approved Paid �, / n � Receipt No. Z
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Date � �/�, ��� � By ' �-
Buildin¢ Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245