HomeMy WebLinkAboutBuilding Permit 1.394 J
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04 V R10 CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT ` T �g �/
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1. Pink File
2. Green City PERMIT NO . /! 3 9
3. Yellow Applicant ']
(Please type or print and sign at bottom) 1 �+
ADDRESS /, t m l e w 0'd ST. s ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ,/"
(Name) � er� M e._ - GLY� L t 'S (Phone) 9s - a ' a 2 / - o % A
(Address) 44 O(O ��,.. ,4: s 4- SE Wr { or Lake rn NJ 5537a.
APPLICANT 11 __ __ (� �'`
(Name) 1"er 1 Q l YL� �Y1.'6f'n (Phone) . 7 to 3 -7-5 - G 2-O
(Address) q 3 20 GI er q r'e'e4A B \v J Nu) &OA - KT 1 cis MN 5
(A ess) St Q (City) (Zip Code)
(Contact Person) 1 A .— Yq ZI rt ken (Phone) 7&3- 167 - eaaR
APPLICANT SIGNATURE DATE S -42 `
APPLICANT PLEASE COMPLETE BELOW
ENEW CONSTRUCTION REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
it 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 �j $49.50
Estimated Cost $ Building Permit #
CA PM Oofw
HEATING PERMIT FEE $ y 1 so p ' Z .'.v O 0 vs SO�ra-
STATE SURCHARGE $ .S --5O
TOTAL PERMIT FEE $ 541 .5b
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid -` 3D Recei t No. C/ / Zn0/
Date- ib // B /'7
Building Official Date '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372