HomeMy WebLinkAboutMechanical Permit 11. 0621 La
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P RI CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIO /FIREPLACE PERMIT
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INN1✓S� 21 . Green Pink City le PERMIT NO. / Z
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 F 1
9inflh 7t4i/ GE r/f La
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER) )/1 5 rf (Phone) P1 7 Ob
(Address) Fjqq( 91 l ri h 11 1 i f 5F: F?o (a re 371
(Name) f I S Mec (air/ 10(
(Phone) 5 e)
(Address) t ' 010 ( 13ty,K y,4' 1 I1 514arorfr i ✓ Cyr / Address) (C Fr: R6Zip Code)
(Contact Person) � (Phone) °' " I ( Phone l tLt
APPLICANT SIGNATURE IkOle.v DATE - 4 " G2' kk
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION [REPLACEMENT ❑ ALTERATIONS
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FURNACE MAKE AND MODEL I YY 1Q�( C JAO FUEL Obi
FLUE SIZE RETURN OPENINGS INPUT 40 t 00D OUTPUT , 006
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.
:AMechanical ❑ Radiation
[r Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System ❑Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi - Family I% 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
tut; tvtuntcavtu Jlatutca y JL LID. t%+o )St $ Building Permit #
"SURCHARGE" has been changed for one
year effective [EATING PERMIT FEE $
July 1, 2010, until til June 30, 2011. Aq .1C
The minimum surcharge for a "fixed fee" permit TATE SURCHARGE $ 5. .50
is $5, beginning July 1, 2010 OTAL PERMIT FEE $ 5)
This Application Becomes Your Building Permit When Approved Paid s, G f 'U Recei No& 73? f
Date "r
Building Official Date 1. l 1 C / By 7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372