HomeMy WebLinkAboutMechanical Permit #12-1270 ��:.❑ a`� c� ooaaoo =� o N�
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P RIp CITY OF PRIOR LAKE � o b� ate Rec d
� �� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� �
� '. P '�` F �'e PERMIT NO. � 2— ��7!J
2. Green City
_ 3. Yellow Applicant
lease or ' t and si n at bottom
ADDRESS ZONING (ott'ice use)
4�Q �I�1 �W00 �� S �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1. � CS 2' �ZIQ°') 1�'V
(Name) � (Phone) I �
(Address) � � � �/
APPLICAN
(Name) t � ` (Phone) � � �
(Address) , , � �v
(Address) (City) (Zip Code)
(Contact Person) (Phone) � � �
APPLICANT SIGNATURE DATE � �
•
APPLIC T PL SE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATION �
FURNACE MAKE AND MODEL � FUEL
FLUE SIZE RETURN OPENINGS INPUT , D OUTPUT O
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.
echanical ❑ Radiation
Air Conditioning ❑ Special Devices Fireplaces with Bog 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
The Minnesota Statutes § 326B.148 �ost $ Building Permit #
"SURCHARGE" has been extended
until june 30, 2013, HEATING PERMIT FEE $ � �
The minimum surcharge for a STATE SURCHARGE $
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid �/) 1 Receipt No. �� 2
'7 .7 � ��
Date � B � '
Buildin¢ Ofticial Date
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372