HomeMy WebLinkAboutMechanical Permit 13. 0329 J
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CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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Ariv E S O
21. . P File PERMIT NO . / 3 _ 034 G reen City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ( V �> _ ZONING (office
! 1 ( AZ I(/ ' ! t/ Nb b use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER i )Or i [A O J PO), /T Phone
(Name) �J �J (Phone)
9q-Ah)- 54)
(Address) \ (.0 (�� N / ( " i3 1 "' `' )
APPLICANT N m 1- (w l Si - t} I - DL- 0 t H (Phone) (t) L' 7 3 3O
• (Address) - ) 1^A titviei.) A 1.),, IG35c' vm,E [M N' -3113
(Address) (City) / Zip Code)
(Contact Person) 3 G l t A 1. (Phone) 10 51 - Co ( 3 6- 3305
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APPLICANT SIGNATURE DATE 4 11,w 43
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APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑W Air Plants ❑ Steam PLEASE NOTE:
❑Gravity ❑ Hot Water Air Conditioner Units
❑ Mechanical ❑ Radiation Cannot Encroach into
❑Air Conditioning ❑ Special Devices Required Side Yard
❑Vent. System ❑ Other Devices Setbacks
FIREPLACE MAKE AND MODEL / * /^' A CIO 6 vi A4 -- ( 3 9 P-
FEE SCHEDULE
Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace $39.50
$39.50 minimum
Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations $39.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $39.50
Estimated Cost $ L I °) Building Per it #
HEATING PERMIT FEE $ > -/ ''- to
STATE SURCHARGE $ .5
TOTAL PERMIT FEE $ 91
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid {/ . Receipt No. j f 4 ( — 7
Date I /% By l , ` ✓� J Buildin¢ Official Date / / T /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245