HomeMy WebLinkAboutMechanical Permit 10. 0898 y 0 ❑ ❑ 0 000000 = 0 > A
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� CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING /FIREPLACE PERMI
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j 2. Green City Date
NO. /0- 070
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3. Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
13 3(b 14 Alit AJ
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
=398 -.
OWNER p
(Name) � (Gl. -YNC. C.7--C6 (Phone) �p�'"g�
(Address)
APPLICAN '
(Name) 0 Ai, .: Ufa' it 1111111101.0 hone) I / ` A I - 1
(Address) 9w �' • � Vd 1 1 � 11 •
3 5 5
( d ens (City) (Zip Code)
(Contact Person) k 1 / L 4 , (Phone) L 1 33L U
APPLICANT SIGNATURE ' Mk / lt
I, A DATE
'______Y=c1c2LVO
APPLICA � ' LEASE C • • ' LETE BELOW
[NEW CONSTRUCTION ❑ 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.
❑ Mechanical ❑ Radiation
['Air Conditioning 0 Special Devices Fireplaces with Box Additions or
['Vent. System / / ❑ Other Devices Cantilevers to the Outside of Buildings
i' Requi a Build ;' g Permit.
�. r„ A__ >._ __ Ar�DJail g AV � . ' It A 9. . . Ai_ 40 4 .ter 7I ' ' / v , * i
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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 $ 55 r op Building Permit #
HEATING PERMIT FEE $ j `/ S/
STATE SURCHARGE $ • . 9' ,
TOTAL PERMIT FEE $ — . •
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ci L vz , RA t No. /_ / L/ 3
Building Official Date D st , 6 ' ( d it Y
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Al
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
_.