HomeMy WebLinkAboutAir Conditioning Permit 13. 0681 z Cl) 1 E u,P W Q z k., 0 5 J z , I � Q
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A—, rRlp CITY OF PRIOR LAKE Date Rec'd
/ Z 'x.Y HEATING /AIR CONDITIONING /FIREPLACE PERMIT
J t---:P"' i 3
41 — �Y` 1. Pin F i l e
NNESO z. ��n c; PERMIT NO. jj h
3. Yellow Applicant /V �fJ 1U v
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
N 2-9 (p �� is s+
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
ran: O hn - Tr h L SO f (Phone)s2 Z3i - (Don
(Address) L+ 2 9 Lo f4t,&+cr. S±
(Name Gexl z- ( ) 9S Z l U'� _ l W V
d 3 r i Phone (� A V' ' 2,
(Address) � 2 W ry, Hwy 13 ' wit l - t ' SS ✓,5
(Address) (Ci!y) (Zip Code)
(Contact Person) A 0 1 n (Phone) , SZ - ' / / • 0
APPLICANT SIGNATURE
MOM 1 tat DATE Le giri 1 dr
APPLICANT PL A .E COMPLETE BELOW
ANEW CONSTRUCTION REPLACEMENT ❑ ALTERAT ONS ! IM
FURNACE MAKE AND MODEL re) kicc z (on C ' 5 �- FUEL L, '
FLUE SIZE RETURN OPENINGS INPUT / COO OUTPUT (� mtlG �O� O �.
TYPE OF SYSTEM HEATING OR POWER PLANT BX
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
echanical
El Radiation
L! r Conditioning ❑ Special Devices
0 Devices Fireplaces with Box Additions or
Vent. System Cantilevers to the Outside of Buildings
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
Residential, Heating & A/C (New Construction) $14930 Residential, Additions & Alterations $49.5
Residential, Heating Only (New Construction) $64.50 ° --- °eaidenti*AC-- fitly-
Estimated Cost $ Building Permit #
CM j� The Minnesota Statutes § 32613.148
HEATING PERMIT FEE $ C M • w "SURCI IARGE" has been changed for one
year effective
STATE SURCHARGE $ 5 .50 July 1, 21)10, until .tune 30, 2011.
TOTAL PERMIT FEE $ S(, 50 The minimum surcharge for a "tiled fee" permit
(Office Use Only) is tic, beginning duly 1.2010
This Application Becomes Your Building Permit When Approved P � / z Receipt No. /j 7.2._
Building Official Date Datez /; 7 4 3 By � /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372