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g HEATING /AIR CONDITIONING/FIREPLACE PERMIT
AP's/ Esc'
.
1 Pink F PERMIT NO.
2 Green C i ry � L `4)'
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
ZONING (office
M O � U n r ^ )L use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1 " ' ' � 4 L (54 C'' (Phone)
(Address) 1 , Y C P\ 1 l\----=_ ' ` L
APPLICANT - 01 _ L'73 - 3305
(Name) f l it — L ) ► t� �' H (Phone)
(Address) 700 ( LO-U(L "W A i& kid P . 0‘,Wf LM /J 531 ( 3
(Address) (City) (Zip Code)
(Contact Person) )0C-1 i•J iN (Phone) (O -1493a 3305
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE:
❑Warm Air Plants ❑ Steam Air Conditioner Units
['Gravity 1=I Hot Water
❑ Mechanical ❑ Radiation Cannot Encroach into
❑Air Conditioning ❑ Special Devices Required Side Yard
['Vent. System ❑ Other Devices I Setbacks
FIREPLACE MAKE AND MODEL A - '`S " U'L� c ✓ ,'-'JCL — I Pi
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $39.50
$39.50 minimum
Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations $39.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $39.50
Estimated Cost $ Building Per ,; it #
HEATING PERMIT FEE $ 1 / - J ► - Li 3. ro
STATE SURCHARGE $ .5Q
TOTAL PERMIT FEE $ 1 32a—
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid j- 5ti Receipt No. 17 9
./ f7 1 2._ By ../_",..L____ .r../_",..L____ ../_",..L____ Building Official Date Date!
F
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 j