HomeMy WebLinkAboutMechanical Permit 11. 0678 O 0 Q O00000 71 o> Eo
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0 4 PRIO, CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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I. Pink Filc
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2. Green City PERMIT NO I
(Please type or print and sign at bottom) 3" Yellow Applicant 11
ADDRESS -
1 1 6 C t - C , r �-- ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
(ONa `
OWNER �C`` \2..'U-SWQ.t'1Sb✓,
��� r'-'\ (Phone 9 SZ Z -`(C7- �1 \
(Address) Ccy\f^ok_ et' r. SE—
APPLICANT
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(Name) �✓b �I� A -eGtk1 l c �
(Phone) 1S2-
(Address) " 1ikkk kv\ ,\ ✓� S E�¢An I rl N`N SS 3`-{ `{
( d ess) (City)
(Zip Code)
(Contact Person) w &ek2 S.?..._0(. • W (Phone) - t
APPLICANT SIGNATURE - _
' DATE 1 C b 1 1
I
APPLICA!PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS
1
FURNACE MAKE AND MODEL
FLUE SIZE
TYPE OF SYSTEM
FUEL
RETURN OPENINGS INPUT
OUTPUT
HEATING OR POWER PLANT
['Warm Air Plants
❑Steam PLEASE NOTE: Air Conditioner
['Gravity
Mechanical
' Air Conditioning
0 Hot Water Units and Fireplaces Cannot Encroach
❑ Radiation into Required Side Yard Setbacks.
❑ Special Devices Fireplaces with Box Additions or
['Vent. System
0 Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL Require a Building Permit.
FEE SCHEDULE
Industrial, Commercial & Multi- Family n
cost Residential, Gas Fireplace
$49.50 mini , um $49.50
Residential, Heating & A/C (New Construction) ---.:..-:_,
Residential, Heating Only (New Construction) $64.50 Residential, Additions
&Alterations $49.50
q Residential, AC C Only ly $49.50
Estimated Cost $ 1 • O() Building Permit #
The Minnesota Statutes § 32613.148
HEATING PERMIT FEE $ . O C.
"St RC1iAR(;1:" has been changed lilr one
STATE SURCHARGE $ �� .Jul 1, effective
TOTAL PERMIT F .Jul y i, 2010, utatil ,lone 30.2011.
(Office Use Only) $ S•..1 . 0 The minimum surcharge for a "fixed fee" permit
is SS, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid
Ric ipt No. (
Building Official Date B
Date S I'' 1�
,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
44 k . '"•-, A.. ;
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