HomeMy WebLinkAboutMechanical Permit 11. 0179 ( O CITY OF PRIOR LA Date • ec'd
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„Iff rke HEATING /AIR CONDITIONING /FIREPLACE PERMI r 1, - 5Q
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2 Green City PERMIT NO. // ��
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14155 Shore Lahr NE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) R L O g 1 Urd Cxtrtnet4 Bec n o 1 (Phone) tiRt ^W c152
(Address) 14155 4ore Lane 1 V E
APPLICANT O 1 i r - - 7 -7
(Name) lM a (Phone) W1 1 1
(Address) I` o`t Vcrrn' 1 1 i m lJree-1- ti C) 55(133
(Address) ( (Zip Code)
(Contact Person) (JQ f le 1% an (Phone) (aS I -143 vi -
APPLICANT SIGNATURE lit 1l .1 - DATE 3 2-1 20
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL GaccmQn FUEL
FLUE SIZE RETURN OPENINGS INPUT 70 t/`j'v` OUTPUT
TYPE OF SYSTEM HEATING OR PO 1 ' PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants ❑ Steam ' nits and Fireplaces Cannot Encroach
['Gravity ❑ Hot Wat to Re quired Side Yard Setbacks.
Mechanical ❑ Radia
❑Air Conditioning ❑ I Fireplaces with Box Additions or
['Vent. System ❑it) es ' V,I Cantilevers to the Outside of Buildings
0 Require a Building Permit.
FIREPLACE MAKE AND MODEL
E DULE
Industrial, Commercial & Multi- Family 1% of jo cos 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
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ "SURCHARGE” has been changed for one
STATE SURCHARGE $ .50 year effective
TOTAL PERMIT FEE $ July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit
(Office Use Only)
is $5, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid 5 4_ ,b -- 0 Rec 'pt No. / Z 19
Buildine Official Date Date 3 2.,5 1 B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372