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HomeMy WebLinkAboutBuilding Permit 13. 0565 (2) 1 mo CITY OF PRIOR LAKE Date Rec'd ` 11, ' HETING /AIR CONDITIONING/FIREPLACE PERMIT 4:._ _ 'sit 3 54 5' O �P I, pink Pile tMvi;s 2. creep City PERMIT NO. 3. Yellow Applieat (Please type or print and sign at bottom) ADDRESS ZONING (uffice use) an 69 7nclah (OW fidr L4ke-dl's_ LEGAL DESCRIPTION (office use only) , A ,l LOT / —7 BLOCK / ADDITION / itih �l�L Sias E .5 ID g5 "' K5 o 7 - • (N ame ) R � VY1'�eS (Phone) 6 752:9f3 - 7z - 72. • (Address) ZDbCp© f• l{',o oire, e + im Lave ti le i� SS/Xk APPLICANT � , ,/ j � r� /� 1 2 / / (Name) � e Sf Li� T r ' i V 'I H O �e (Phone) W 5 r 10 53 - 2 SLO / • (Address) 2`100 -Fai v V i e v3 Ave, !i ie_ose.U1 1 /e f Oki '5 in (Address) (City) / ` (Zip Code) (Contact Person) Leah L d /� er�1e k �� (Phone) (061 ` � ? •.� ei 1 2 . APPLICANT SIGNATURE \ j DJQ _ DATE Z APPLICANT PLEASE COMPLETE BELOW , ❑NEW CONSTRUCTION ❑ REPLACEMENT 0 ALTERATIONS • FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Watat 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 ❑ Special Devices :Went. System ❑ Other Devices Cantilevers to the Outside of Buildings ` � p, Jrl (' I� Require a Building Permit. FIREPLACE MAKE AND MODEL y � -al 1 V C/1V ,, C c�V FEE SCHEDULE Industrial, Commercial & Multi - Family I% of job cost Residential, Gas F ireplace $49.S0 $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 Estimated Cost $ Building Permit # The Minnesota Statutes * 32613.148 HEATING PERMIT FEE $ "SURCHARGE," has been changed for one year effective STATE SURCHARGE $ .50 Jnly 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ .rhe minimum surcharge for a "Cxed fee" permit . (Of i lee Use Only) Is ,t i '._', beginning July 1.21110 • This Application Becomes Your Building Permit When Approved Paid - Receipt No. Date By PAID Willi i BuildineOfficial Date BUILDING PE RI r, 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 •