HomeMy WebLinkAboutMechanical Permit 12. 1015 J I
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i r R/ . CITY OF PRIOR LAKE Date Rec'd
4 � e HEATING /AIR CONDITIONING /FIREPLACE PERMIT k i, ,,.
41INNESO ' . P L ken PERMIT NO . I r
2. Green City r Z�/ �`J ........y
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\ — 1 a Oa_ k--rl
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` 1_ C _ y
(Name) -.1 ex- q., k\ I �O,I.S� (Phone) (el - - 1 0 11 1 L)
(Address) 1l ,- 3 2S +: ,1,A,r r o Lel . `(\ { (0_1(0 . • M
APPLICANT
(Name) -- HEATING & A/C, INC. (Phone) 0 15 1 C1 C ��J
3451 W. Burnsville Parkway
(Address) Site 120
PI irnsville, n89337 (City) (Zip Code)
(Contact Person) (Phone)
. 6� 1
APPLICANT SIGNATURE L ��'Q� � DATE ( ETJ 1
PLEASE COMPLETE BELOW
NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
MAKE AND MODE :st 0-1 CrAI (9y :C49 AA, I_ 3'Ia- - 6,- - )
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 Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices
❑Vent. System ['Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL 1fY4 O ` p,LVILL(r o____2, 1 f}( 4 G t , G
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 #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $cA . ap
until June 30, 2013, STATE SURCHARGE $ e :D ME)
The minimum surcharge for a TOTAL PERMIT FEE $ Sq i,5
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid S4 0 Receipt No/ Id/
Buildinu Official Date Date ?Ai // By iN:
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372