HomeMy WebLinkAboutMechanical Permit 13. 0950 CA
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o� PR/0 CITY OF PRIOR LAKE C/ Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT p ., 6 .. cp
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ti . 1. Pink File PERMIT NO
INNEso 2. Green City q,s.-j1 CCO4
3. Yellow Applicant
(Please type or print and sign at bottom) J
ADDRESS ZONING (office use)
i63 V o//170E .. Dg. 7-
LEGAL p � � O c us�or�ly I.
LOT (� BLO J ADDITI (C K PID 25 VoZ - 1/3 Cr
OWNER ®® _
(Name) �J2 `)" �CIT� h b& 1Z s (Phone) � 4V — j_ r � i
(Address) / (37 9 77in 6 .6;---.4:3k-,, 7 7 ' t 7 .L.-e.
APPLICANT ��)) (;� ��
(Name) C�N7Y516( f'!' ihud ilh. _.z Az . (Phone) / , -'$9 • , 9
(Address) ) 01,01 4/ otir M.vOALE v2 , i�L / mU61 , rn ■J' 55 37
(Contact Person) c,:v ibic - ; � (Phone) 9 - �-yi5j
APPLICANT SIGNATURE OM DATE g 3— 1— /3
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION KREPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑ Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑ Gravity ❑ Hot Water into Required Side Yard Setbacks.
111 Mechanical ❑Radiation Fireplaces with Box Additions or
igAir Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
❑ Vent. System ❑ Other Devices 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 .Besidential AC Only $49.50
Cost $ y9 S!J Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5'y- y
This ApplicatioA Becomes Your Building Permit When Approved V. le h! , Re ceipt No. j„ G�i r)
e '3 C . (3 �J ` la lI� / Aik Building 0 Or Date II ate a Q 30. ( 3 By 54 -.
24 hour notice for all inspections (952) 447-9850
4646 Dakota Street S.E., Prior Lake, Minnesota 55372