HomeMy WebLinkAboutGas Line Permit 13. 0653 0 0 CI
0 000000 'CI 0 > z g
A n \ 000
0 0�2��� § m U � 4
k§ k k �� ® q m �
to t \ � � k � z -
Q o
o 2 q cn 0 z k z m
% co : a o
0 7 z 0 0 2
M z n
) 0 r C m�
>a m \ 0
k c.
K mqq % OOOeo
] x Z . $ r - a trn � � ..
k 2 k / / , kk§P3 m 0 Co
C m 0 z§==�z m z ?
$ a o 0
r \§ p q
% /
? , m 0
/ \ \ § ii ` § c
_ X �
o ®
<
$ m
z O 0 0 0 0 . -°
° 0
>,373o d • m
<
���
0 \\� ��
ttl \ m _ �mm - ' i
■ ® � % '.-4
»cnt z ■�' (
®r. 0 ` c
* ��
o� PItI
,,, AN ,
CITY OF PRIOR LAKE Date Reed
HEATING /AIR CONDITIONING /FIREPLACE PERMIT Pul6
tri kNE h/33
1. Green Fiit
2. PERMIT N )
Green City � / � ^ O / /, -
3. Yellow Applicant / W v
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
15 /5hvJ Virg go(
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) k5n * 3/�
0 90ay) (Phone)
(Address) $kC V f _ O ?) C ;(
APPLICANT n /�
(Name) I ✓l ' I lk 1 l (Phone) q5,; (0) ( 63
(Address) / /1 lX..) , L . _ Y 01 0 r✓l u 53
a ,o (Address (City) (Zip Code))
/� V
(Contact Person) I ' 0 ( 1 . 4 jLj# (Phone) 7 (� sad- -)c i nJ 9
APPLICANT SIGNATURE A _ ) 1.,,,. t.„,,, t.„,,, . , / DATE /C3_g_.// 3
APPLICANT PLEASE COMPLETE B LW
❑NEW CONSTRUCTION ❑ REPLACEMENT ERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
harm Air Plants `` ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity N !` \ \ �} ❑Hot Wa into Required Side Yard Setbacks.
❑ Mechanical (_V`' �(\ ❑ Radiation
❑Air Conditioning 0 c61\ ❑ Special Devices Fireplaces with Box Additions or
❑ Vent. S y stem Cantilevers to the Outside of Buildings
❑O Devices
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum — z� —
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ c/(, Building Permit #
HEATING PERMIT FEE $ L I C' JD
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5 LI , S 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Date (� � gt / —6 Receipt No. 7 ;
/ / By
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372