HomeMy WebLinkAboutFURNACE AND A/C y 7 k _ S o Zc?
c�5 p () 0000❑❑ / 0 O cnm '71TT O v � �
p p 3 qz�(n c0 z m mo
C, D ` • z 3 mrc� z 13 m c 1
1.,1 r m 0 -- m v > z O z N _ �
N z - o = O
IC! - -1 N ' bi. N z z o -,i
S. _c_ ,_,,
- 0 D O n z y W
__ 0 m m
Z r p , \j) (�
r
- I
a m °� 0 o j ❑ ❑ ❑ ❑❑
1 Z. ral Alb
Z m m m 1 , 1► �y*3� 1
x c
s g Z v v Al o (� i J m=om m O n
i O N j
m Z z = = z r _
C m m -4 3 -i m
0 b -+ o z z�� z r
r=i O
z T
A 0
= m N—
c 0 j
r ❑ ❑0000
N m
o mmn �' ! _w i
R. A 0 comma n) m
v
'I '''.
I Z D 0 0 `
C m z Tx � r
N Z — Z _,
E
r 0
V RI o CITY OF PRIOR LAKE Cy Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
x
INNESO 1. Pink File
2 Green City / PERMIT NO . /{ z /ry����
.
3. Yellow Applicant ���...JJJ VVV
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\w ' �3-) Nc,�S \ i'Lc< A
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1) ti∎ v1 \ .J Q Y1 i`N k t'\ (Phone) c I r c) - ( 1.) `t, - 34
(Address) \ <) r\ l (• \
t ' k
APPLICAN _� � -
(Name) ' �--�$ 1 � - (Phone) �t
(Address) WO \S 0 \`-'"\ LV f\ iC 9 (1 O✓' LA QX S c cl',
(Address) (City) (Zip Code)
(Contact Person) N 1 v S P.-f\ t.' (Phone) Ci '\1/4 9 '' 1 ..
APPLICANT SIGNATURE C` DATE S - A 1 d
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ,REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL ( Sr - \ c,,$ CIA A .CO FUEL iY ti
FLUE SIZE IR Y & RETURN OPENINGS INPUT ( 0 '.nom! OUTPUT kQCS
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
,4Warm 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 �7>r\9 -1 ❑ Special Devices
❑Vent. System j.Ao (M iN \ ❑ Other Devices 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) $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
until June 30, 2013, HEATING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ S fvSo
"fixed fee" permit is $5.00 COTAL PERMIT FEE $ c Li Si
This Application Becomes Your Building Permit When Approved Paid . 17t,-) - Receipt Tyo 2 -
`7` ii t,
Building Official Date Date , By i
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372