HomeMy WebLinkAboutMechanical Permit 12. 1185 - 0 0 0 00000 0 > E0
A 0 \ 0 0 0 0 \ƒK §§ z k � �
0
k \ Mm m )� §§2f § $ q �
% t b m d � � � z -
& w 0 ¢ 0 � k § m
) -I 0
\ \ 0 k 0 2 ®f k K
\ 0 / -C
¥ 7
• � ^73 0 0 000000
q q qqq C "0 *0 13 r
CI H z o 0 O a - C
7 M
>4 CA E 0 , x§ = § m 0 k - 0 , ...
>z \ 9, § > 0 2 0 vs $
:1 \ ƒ } r- } x ® P ` E
2 § P. ) §% o � � §
• ■ 0 C � _
} .�
, Q-__
\ 0
0 00000
) 2 ƒI] § § t §
R. 0 0 Cqm§®
\ i 1, m��� ihi
\ R A ® r -4
® z - ■
Au 0
i r It CITY OF PRIOR LAKE Date Rec'd
N " HEATING /AIR CONDITIONING /FIREPLACE PERMIT
-
Q _ r
41ln'NESdcA Pink File NO. NO
PERMIT
2. Green City PERMIT 1\ / 2 . _11,3
3
3. Yellow Applicant / (J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S 4 9 C0ca S;
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Name) /y� 1 W` % 1ic-c- (Phone) 9-S r*
(Address) £Y 9 CrO $.Sanefra... S
APPLIC �/ / (� / j �
(Name) 6 D r L e.I.e.. j $-2 L (Phone) 99 �— 4 1 7 �} // `/
(Address) / 1 " J)b1C- . � oo t e )7,-,,,,,--4..x,_ ,,, SS- 2I2
(Address) ' (City) /� (Zip Code)
(Contact Person) _ = y � ,i L (Phone) N 4 17 / 80 0
APPLICANT SIGNATURE I DATE /L g — c 2 1 Q
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION IE REPLACEMENT ❑ ALTERATIONS
A -�Gc,.�
FURNACE MAKE AND MODEL 4.. i � -X FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
T OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
■ Mechanical ❑ Radiation
• L it Conditioning ❑ Special Devices Fireplaces with Box Additions or
■Vent. System 111 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
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ S4LS
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid / Receipt No. 4 7 2. f
7- i
Building Official Date Date / O /� J By
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372