HomeMy WebLinkAboutBuilding Permit 12.851 Heating o. t Rr CITY OF PRIOR LAKE Date Rec'd
H HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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iNivEsoo 1. Pink File
2. Green city PERMIT NO. 12--‘2,51
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)
APPLICAN i�) --
(Name) rQ 1 b! / l e �I n 1 (Phone) 671 3‘6. --3 ' f
(Address) 3 O 5 P- Pr` 1h,9 77 5" iri-'' Pt, la /,P/Ci 1 1i 11 7
(Alfdress) (City) / (Zip Code)
(Contact Person) eh.2'/ i -0(14 � (Phone) •(, , _ `' 4
APPLICANT SIGNATURE i r '. 1 DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION El 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.
D 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 $ 6S co Building Permit #
HEATING PERMIT FEE $ 5t.�'_
STATE SURCHARGE $ .5(1.9
TOTAL PERMIT FEE $ ( Zj
(Office Us • Only)
Thi i .: ti 1 . e , meYour Building Pe mit W n Approved Paid Receipt No. e A4591. Z Jo ( '2_-- Date By ,� .
-: uil . Officia =.r D to / ' �7( t_ ' 1_6 k-
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372