HomeMy WebLinkAboutFireplace Permit 13. 0521 J
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?Ri + e OF PRIOR LAKE Date Rec'd
� HEATING /AIR CONDITIONING /FIREPLACE PERMIT
. , 2 . Pink File PERMIT NO .
2. Green City /3-05z/
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ..---) (office use)
56 C l - aeaSSwebri th k- '' 16,D
LEGAL DESCRIPTION (office use only)
LOT / - BLOCK ADDITION A) I G 2 0 U2$ ✓ A D 6 AI PID v15- 1(0- 0.3g1)
m R ()ft 1 t i P- (Phone) S
(Address) &50 6459,60z0 e,, ri/i o /t.0 (/ ✓ iA" 5
APPLICANT 125g -19a -9;2 7 6
(Name) C �. e � 1-kay--141-- �' (Phone) `
Address el s I do k r *I 1. 4 14 1 S ..
(Address) / (Address) (City) (Zip Code)
(Contact Person) )'>'1 ! 1 --- ■ (Phone) 1 ,- — • — 7 ay APPLICANT SIGNATURE / f DATE 'd
APP /ANT ANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT 10-KLIERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warn Air Plants 0. Steam Units and Fireplaces Cannot Encroach
❑ • : vity ❑ Hot Water into Required Side Yard Setbacks.
echanical ❑ Radiation Fireplaces with Box Additions or
• it Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
['Vent. System ❑OtherDevic - s
Require a Building Permit.
FIREPLACE MAKE AND MODEL r b Z li l ik .I Ol
EE SCHED
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas F $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
The Minnesota Statutes § 326B.148 'ost $ Building Permit #
"SURCHARGE" has been extended
i > _ e 30, ? i , SEATING PERMIT FEE $ 99 e
The minimum surcharge for a TATE SURCHARGE $ a CA:
"fixed fee" perrririt is $1.33 COTAL PEPMIT FEE $
This Application Becomes Your : ildin Per it When Approved 'd 19 i t 3 Receipt No. I i a
PA--- c / 3 Date � � By sk5 ...
lie Date J
-
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372