HomeMy WebLinkAboutFireplace Permit 11. 0388 ? <0
$ = a ƒ Y §
� z��� $ z
,� § 2
aWW2 e <
< / k �§0 t I 2 z lit
0 d i
--M .)-OOO I � &
I,: 2 al C l (i / IOW m /
I .) � §§ I z 0 § 0 t 2 §§ § 0 o ° r: / z Lt k_§}§� � 0 c - ® d r2
z ® «
IZZQ U j § § § I" tit
OOOCOe o o o § $
a a e
o < < 0 \
' 1--
z _ 6
\ / M 1 - 8 \
P % w a
2 z /o§ 0 Z k� mr §
�R § k§2 - - 2 § § l < Q
�� W w z Rgrt 2 - S S \ o Q
$ R 0 uu� @U.en Q
a « o a 000000 0 E) , 0 0 -
( (vR/ - ( *. CITY OF PRIOR LAKE Date Rec'd
*Ili' HEATING /AIR CONDITIONING /FIREPLACE PERMIT
H 3 �
g
N„ 1 . ik /J � -) g 2. P Gre n en File City PERMIT NO. / /, 3 (s 3. Yellow Applicant (/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3a,_3 arc
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER , _
(Name) x r t C1i i� Z. i m rim r P hone) 4 - r 7
(Address) -5),:)3 CjQ c)
APPLICANT _ 1 C ,, 11
(Name) TI IM � . YC- '11er`s ,Ci f (Phone) ( 1 . �i-N — — fq
(Address) 1o 0 . ' J ' ] ' _ . S 111 1 r ar m
(Address) (City) ` (Zip Code)
(Contact Person) (j _LL q (Phone) _ ` r•
APPLICANT SIGNATU' et DATE #.o / 1
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS I
FURNACE MAKE AND MODEL cL — � - Pm C (E r( s FUEL -Jct f l L
FLUE SIZE ( RETURN OPENINGS INPUT LOO (..0r) OUTPUT _
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
❑Gravity ❑Hot Water Units and Fireplaces Cannot Encroach
R ■J echanical into Required Side Yard Setbacks.
❑ Radiation Fireplaces with Box Additions or
Conditioning El Special Devices p
• Vent System El Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
1'IREPLACF MAKE AND MODEL - > - u-s P -1.
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 $ Building Permit #
'The Minnesota Statutes § 326B.148
'i � "SURCHARGE" has been changed for one
HEATING PERMIT FEE $ ` 0 .50 year effective
STATE SURCHARGE $ 3c 6 i :5O July 1, 2010, until June 30, 20n.
5 �
TOTAL PERMIT FEE $ . c-3:::) T he minimum surcharge fora "fixed fee" permit
(Office Use Only) is S, beginning Jule 1, 2010
This Application Becomes Your Building Permit When Approved Paid Re t No. c r/ (/�
Building Official Date Date ( / I � o
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372