HomeMy WebLinkAboutAir Conditioning Permit 13. 0625 y 00 X
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PRIp CITY OF PRIOR LAKE Date Rec'd
H �A9 HEATING /AIR CONDITIONING /FIREPLACE PERMIT
4'jNNESO , Fink ile PERMIT NO A /
3 . Ye FCity w Applicant /�� /I /n���
3. Yellow VVV YYY///
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
` 3O5 - 4) Qo9Cak --A NW
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �/� cc
(Name) ��. �l\`QO A (Phone) ( Q I a O"a -JapLp
( Address) 30S1.1) MO W - 1)2A TVW, VAMP (fAV11 nri G5 ?
APPLICANT 11 n` /�
(Name) U in SAO- \ - &t-\i nc AC— (Phone) q' 5 oR - �C j Li O O 0 S.—
(Address) (S 5\ W. �u n.VlIti 1� n CW■1 4.-V Y TS33
(Address) (City) (Zip Code)
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(Contact Person) �/y1 Q- (Phone) / "1 Sri ( GI-0110 7
APPLICANT SIGNATURE aVAAAAM 6 DATE (pig-13
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ►elf REPLACEMENT ❑ ALTERATIONS
F{7IUrivIAKE AND MODEL Y y k- 113 Y V\ O3 (0 prrt 3 ibn
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water
❑ Mechanical into Required Side Yard Setbacks.
❑ Radiation Fireplaces with Box Additions or
f Xir Conditioning ❑ Special Devices
❑ Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
.. • - - _ , = - , =L ) \CAULK wVvf Te31‘,LE,JA Ac..
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
,ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended -EATING PERMIT FEE $ L-49.(5
until June 30, 2013, STATE SURCHARGE $ 6,CCe'
The minimum surcharge for a
FOTAL PERMIT FEE $ 5L1-
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid 1 --- j/ 37) Receipt No. ` g3,43
Date / / /, By I � Buildine Official Date IG� �!J
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372