HomeMy WebLinkAboutHeating Permit 12.0380 0 4 P R1O CITY OF PRIOR LAKE Date Rec'd
3 x HEATING /AIR CONDITIONING /FIREPLACE PERMIT
111INNES� 1. Pink File
2. Green City PERMIT NO. / . . $3 0
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 S R9 c1,v1-k. Rd
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` ` /,, f '
(Name) V e--r00' �6v 4Y\SOV) (Phone) 95 2 - ' / Al -- 7 - 6 - 43
(Address) F sal c PT, Ak- '1 4d `1 CiY Letke0. OW J. 3 7;
APPLICANT 6 ,, ` _ (� -7 P , L � y
(Name) I �GY l \ 6 �1� Cne-rn (Phone) to3 '° �J 3 r -5
(Address) _ 0 ,gi __ A DI / V K- - it t 0 ✓/ 0 d 5 I 33 .z
Ann (Address) f , � (City) ( iip
A
(Contact Person) _ I ✓tI & I , I (Phone) 769 - 783 - 5 - t7
APPLICANT SIGNATURE f�,/ iii �, _ _ DATE
■ -
APPLICANT PLE • SE COMPLETE BELOW
❑N WW CONSTRUCTION V REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL 5fS 77 O4' 6150 T 4 (57()-- / FUEL / V arbS
FLUE SIZE RETURN OPENINGS IN PUT `� ; D / 7� S 30000/4 ,0/
TYPE OF SYSTEM HEATING OR POWER PLANT
Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
Gravity ❑ Hot Water
❑ Mechanical into Required Side Yard Setbacks.
❑ Radiation Fireplaces with Box Additions or
Air Conditioning ❑ Special Devices
❑Vent. System ❑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
r _` -- --- rost $ c10° ' °C) Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended h/ HEATING PERMIT FEE $ , S
until June 30, 2013,
The minimum surcharge for a STATE SURCHARGE $ 1 j,1Cz:5e'
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 51. s °j
This Application Becomes Your Building Permit When Approved Paid J --U Rey- No. 6 ,... s -lie
5-7, Date - ( 3, 1 /
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372