HomeMy WebLinkAboutMechanical Permit 13. 0371 C 9 J QQ
Z zf2 U
2 J a u. r _ Z w
~ LL U U a >
l'5511' g z Z
c�0wereQ w
W Uu ti C9 > rY
° ' ❑❑00 U
W _
qk v
O N
LL r _
w c Z w
J Z ° 0
W p nD‹ p U U oG z 0 Q ; H 0 0 0 0 0 ■ W ° 3 a O a. G..
i Z a z�x N O ? a
co 0 a. 2xw2i __oat( _ 0 oG
a23rna� Z
'�� 0
. 0 =
00000 0 �)
r 0 p 0 o o
Ix p (0 w
o z z 17- N 1- .�� a a. a Z o p w F- (1) w w w Oi
a O_ Zaz� i W w L ° a 41
a c~i w o ow�aw 2 0 w o a U v rZ
w W m Z h-
r a 0 0 LO � zu .in O - 0 c
U z < 0 a 0000❑ ()
.
c 4/1
CITY OF PRIOR LAKE Date Rec'd IL ,, H EATING /AIR CONDITIONING/FIREPLACE PERMIT 5 , (; (3
NEso * 1. Pink File ` . PERMIT NO
2. Green City < 3 _ � "7 C
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\ . 5 Q /j cJJ
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �Qs (Phone) '752 -'IV 7 -691
(Name) ��� � .1, CU.12
(Address)) «
APPLICANT
(Name) g e$ pea S Ti (Phone) Q 52 - 767" -- (%
(Address) X04 Ac ,wt,,k P & 2
(Contact Person) A/ 41k (Phone) Q'S - 76 7 - CI /425
APPLICANT SIGNATURE iiteGzdkt1..._ DATE 5
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION III REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE '-i + 4 N RETURN OPENINGS INPUT OUTPUT ad
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 Fireplaces with Box Additions or
❑ Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
❑ Vent. System ❑ Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL IM2At 6 b40 i
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
Cost $ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.01
TOTAL PERMIT FEE $ /.i -'----
mat
This Application Becomes Your Building Permit When Approved Paid 5 Rec o , a pe (
Building Official Date Date _ (P IN,MIM
24 hour notice for all inspections (952) 447 -9850 /
4646 Dakota Street S.E., Prior Lake, Minnesota 55372