HomeMy WebLinkAboutMechanical Permit 12. 1471 J
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4 r RIO CITY OF PRIOR LAKE Date Rec'd
V4t HEATING /AIR CONDITIONING /FIREPLACE PERMIT
- 6 �
'IN NES o`'e' 1 . P F y PERMIT NO
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
310 3 ukV CY *. UrC .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ouky C \ N (Phone) (--( 2 -- 3 i j - (D : � L-1
(Address) 3205 (iA\4C.brnU GEC
APPLICANT j
(Name) -6I,IYY\SV 1 \ [ L. N v k; V1 ci 4' Ac., (Phone) l "I '
S 2- got cl - oco
(Address) 3L-15 I Vv- 3vw()SY\ 1lt ' r \A) l *120 6U YSvi z)s35
(Address) (City) (Zip Code)
(Contact Person) \ \O 1Y \ e._ (Phone) c' - R °I LI "COOS
APPLICANT SIGNATURE .. .I lVtM v( DATE 19/15//
APPLICANT PLEASE COMPLETE BELOW
ENEW CONSTRUCTION t4REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL y(\. yy\ - 3 \0 PlyzNal-la O Q FUEL nr4
FLUE SIZE RETURN OPENINGS INPUT CIO, 000 OUTPUT 2,a__CCC
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
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
HEATING PERMIT FEE $ ' c 5 - C' "SURCHARGE" has been changed for one
STATE SURCHARGE $ .` 0 year effective
TOTAL PERMIT FEE $ 3y °5
July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit
( Office Use Only) is $5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid \`i .v Receipt No. l0 7 d p
Building Official Date Date /��ek By ��
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372