HomeMy WebLinkAboutBuilding Permit 11.832 Heating C iN Y RIO CITY OF PRIOR LAKE Date Recd
DTI /AIR CONDITIONING /FIREPLACE PERMIT
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vESO �A 2. P File iY P ERMIT NO.
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT 1
(Name) — sl�fy/M' f /5; �/ O/ TG/yfflJs�iC✓ (Phone) ej /,'ay0 7/3 6
(Address) ,9?�/ */1-10/1/77 U ‘071, //7/( LC %
(Address) (City) (Zip Code)
(Contact Person) ' ' 1 . ' /i✓ (Phone) 6/0?
APPLICANT SIGNATURE A4fl A 1 ' DATE -
A LI NT PLEASE COMPLETE BELOW
NEW CONSTRUCTION CI 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 ❑ Other Devices WA /, /∎l Crioteee Cantilevers to the Outside of Buildings
3-6#1.5bi✓45 Require a Building Permit.
FIREPLACE MAKE AND MODEL 'la* O(/EN.' k/HH
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) $64.5 / /� Residential, AC Only $49.50
- '°`=-- -`° ost !// Building Permit #
The Minnesota Statutes § 326B.148 f
"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 $ 97 Q
This A• j c n Becomes Your Building Per ' Whe , Approved Paid q Rece' No. 6s7 /
Buil 'n¢ Officia D e Date ` /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372