HomeMy WebLinkAboutFireplace Permit 11. 1292 / 9 e 2 o'..
W. E
0S® 1 2
� §k 7
& a a ao o
w . 0 � ) �2 L
o ■ .s.-i. UJ0 ko § ? §
D OO=O o &
. I u m
N
— $
o
w
g / ...) CL a § t § k
Ill d 2 D« . w
O -I ci t. 2 00 0 0 0 _ -
X z b z —XIZ 0 k I
O 0 w Ei LL ■ce a L" ( l f 0 C) (
q % Q §§§ §jj w w k 1-
11 ■3 w -
111
®
O ❑ooEe � 0 j § Z $
dw a
\ a a e
t 0 k 0 2\
m0 2 — � wz ° §
Q . z z 0 £ 2
2 § § § 'S
§ 0 0 8 <
� g Po- § z U �� w
�R 0 Z §z _ , a ; 2 ƒ ) § ?
� et w Z §R12� 2 2 00 k ° Q
§ 0 § 0 u.u.u. § _ � p
0Z < 0 a 0000 -o 0 o o E
4 r R t , CITY OF PRIOR LAKE Date Rec'd
° � � 4 L, HEATING /AIR CONDITIONING /FIREPLACE PERMIT
I oz�. 1. pink File
2. city !/ / PERMIT NU / 1 / 7
Nte�eS n [./
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) S- o 1(-)er- -- a '`-'\.(), \-A \I C \\`■`Q . (Phone)
(Address)
APPLICANT
(Name) \C3.Ye \--V Cin f\c d A `C_ n \ \�C`x \\
(Phone) — 1(..03 -61-42--t k Lo Lo
(Address) � �j ��).(Y�,c-. h A\ j4_, CIO U �YV k2 i
(Address) (Cit) (Zip Code)
(Contact Person) ! sr (Phone)
APPLICANT SIGNATURE am ll . DATE 1 "Z - 1 i
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT WALTERATIONS L c� \ \ vim.
FURNACE MAKE AND MODEL FUEL
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 0 Special Devices Cantilevers to the Outside of Buildings
['Vent. System ❑ Other Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHED`
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 $ 3-6, d Building Permit #
The Minnesota Statutes § 3268.148 f
"SURCHARGE" has been extended HEATING PERMIT FEE $ L1Q . 5 c:).
until June 30, 2013, STATE SURCHARGE $ S. O ,r1
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00 S'4. SO
This Application Becomes Your Building Permit When Approved Paid c ' i . S U Rece pNo(�471—
Date By
Buntline official Date / Z, 2 , . t /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 ( J
4646 Dakota Street S.E., Prior Lake, Minnesota 55372