HomeMy WebLinkAboutMechanical Permit 13. 0030 J
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VRi CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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4fI NNESO� t P`' F "e PERMIT NO.
2. Green City 1 / \ ,3d
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) R VI 11 Y\ (`' tN r t (Phone) � `-S .> - - � 1- J �O tp
(Address) \ . 0 k. v 1/4 :3 - ^` k . tc •,.... l) , , SV \v V1J S 1, .— l...-- c l c x S s' 3 7a.
APPLICANT 0\51_ ( � `
(Name) s —% i l- • ^ .-4---in 1, (Phone) _' d -\\ 1 " O i c q
1�C,vC` vV „ i
(Address) � \ O V � `\ `. � A � ♦ L1 ^k—ck Cst, S `S - 31 A
A (Address) (City) (Zip Code)
(Contact Person) (`-\ L S • \ ' (Phone) C I _\-- g- " \AL n - C� 1 a Ut
APPLICANT SIGNATURE _ _dm, ,■ DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL (jr� j �, �� �
\L) � \/(, ' ( FUEL N k...*
FLUE SIZE RETURN O OPENINGS INPUT OUTPUT T S1,0(3()
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravit ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑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 $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
kk ti
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HEATING PERMIT FEE $ -K,
STATE SURCHARGE $ C5 0
TOTAL PERMIT FEE $ S k k /-
(Office Use Only)
This App • tion Becomes Your Building Permit When Approved Paid c Receipt N $ z e
.#?-‘ Date By
Buildine Official / Da f — / re...v....0
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372