HomeMy WebLinkAboutBuilding Permit 11.797 Heating p RIp CITY OF PRIOR LAKE Date Rec'd
0 :F AIR CONDITIONING/FIREPLACE PERMIT
U INNESD 1. pink File PERMIT NO. , - 71 7
2. Green City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
G a la\)V)v... S 1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �p
(Name) l 1 3 - silt *k l T
(Phone)
(Address) C % CS. i. 13 J ' 11t\ ST
APPLICANT U
(Name) C sJ STt1 ��6,J C. S �6Z`1) C'�S 3 (Phhone) 6 5 1 S `\ '2 S )1".
(Address) ) C. 13 ��L)c_t . N it 2...,V ��) ""'C r3 ` 'A L_O12'� &S) c�
(Address) (City) (Zip Code)
(Contact Person) J 'E 11,'1 E. 1 .--- s- CT (Phone) ( 4 ) S z5 1 i'
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE 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 0 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
Estimated Cost $ - I 0 v a7• Building Permit #
HEATING PERMIT FEE $ r 1 50 Zq •q�
STATE SURCHARGE $ �0 p
TOTAL PERMIT FEE $
(Office Use Only)
Thi / ■ 'cl 'on Becomes Your Building Permit hen proved Paid 5 ZA Receipt N�
A, d1'� S (t' Date aa By Y
, : uildine 0 'al Date [7 (, ( •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372