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Mechanical Permit 13. 0184
0g . 0 000000 1 3 0 > zg 0 u) - n § $ v $ ) a 0© 0 c �z o z m w m0 rti 0 0 k m / % §�} z / \\ k « \ m m ¢ Z § ' Z- M ' N *› d cn § z 2 z 23 a \ c:e ti ' k -1,1 A \ 0 z x r 0 3 » z 2 T. 2 . X 000000 z m m m ® . 13 u) C2 , % *21 j ? §0 a � ® §$ § � \§ m p % 0 O \ / § § �° . / §/\ xi k p s q- U k \ t c z . / % z P. m � �� 0 w i a 3 = q g 0 ‘ n m < . .\ 000000 § 0 ` 1/4)1' w_\kR§ . � ) J ®mm ■Q % < o . E � - 0 ro �. nn - - "T1 0 � \ >\M \7 K § m . -4 z - § w 0 C P RIp4. CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING /FIREPLACE PERMIT = ( 1 3 , v ; t, L e i 3 tirNNEso 'c''' bi- P" F PERMIT NO. 1)) 2 Yello w Applicant Cit . / 3. Yellow (Please type or print and sign at bottom) ADDRESS ZONING (office use) E31a --- Rcjto∎ Y\ Ofl 0, `•rc!t S ` .I LEGAL DESCRIPTION (office use only) LOT 0/1 13LOCK 1(ADDITION Zrt i, ' j 1 1 -c t4; i 1S uis2 Add, PID a5 lg !' 60(i—e, OWNER i 1 /; (Name) if1 i �' 1 � P� e C 1 ( Phone) < o� " Y �l " 5 / (Address) 63 . gG l r & y 6.►, a. APPLICANT A (� (Name) l e,n ( ' 1 C 3 4 Y 1 . CY\ 2 3L (Phone) ' 7 tv 37 - .Sj y (Address) - 1 3 `11 E V ern r'4 N &L► k 11 (.E9t3✓1 ic15, r" N 6-5 '7 1 33 �/ � (A ress) (City) (Zip Code) (Contact Person) : .I G F Vt ►'1 At i Vl.Ice, (Phone) 7 ('3 - 7 - S ` Sq cc/ I APPLICANT SIGNATURE I F, Ji DATE a0 APPLICANT PLEASE COMPLETE BELOW ❑NEW CONSTRUCTION ` ❑ ALTERATIONS FURNACE MAKE AND MODEL C. , e---Y 5 �1a r c CY] ( -1 Z' FUEL k 02.1 u. rea ( 4ers ' FLUE SIZE RETURN OPENINGS INPUT OUTPUT S, f 3c0 TYPE OF SYSTEM HEATING OR POWER PLANT ` ❑Warm Air Plants PLEASE NOTE: Air Conditioner al ❑ St eam Units and Fireplaces Cannot Encroach AS Gravity 111 Hot Water into Required Side Yard Setbacks. Mechanical ❑ Radiation q ['Air Conditioning ❑ Special Devices Fireplaces with Box Additions or ['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 $49.5 '' Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Cost $ Building Permit # HEATING PERMIT FEE $ T 9. (S© STATE SURCHARGE $ S 00 A4- TOTAL PERMIT FEE $ 6Y 0 (Office Use Only) 11 This Application Becomes Your Building Permit When Approved �� i ll 1 3 Rec eipt No / /// (08469 Date Buildine Official Date 3 ( � � 4441. C 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372