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HomeMy WebLinkAboutFireplace 13. 1234 / = 0c� 0 000000 " 0 a E 00 ■ 0 ■�g -n il- 0 § § 2 n 0/ ©0 0 . C A§ m m m n. k § k k§ m 5 �k -kk 0 0 �v El) 2 Q 2 / t § > - © @ § © / 0 % 2 � % 2 CO m m ii % r - ■ $ o m kk� 000000 % Z mmm ■�®■ ■� c \ �� �k X ■�§ m O n K 2 ƒ . Q 0 3 1 § r - § q • c `17 z r. -o'a 0 r z m ° / X 77 tq ƒ 0 o . ., 2 0O OO ti z a 0 ©§ z 1 2 v C §V�$ \ -mm�- A +_ 2 2 ■ �§ § A ® r Q 0 0 1 PRIOJP CITY OF PRIOR LAKE Date Rec'd IDEATING /AIR CONDITIONING/FIREPLACE PERMIT g (1(1.3 1INNESO�� 1. Pink File PERMIT NO. 2. Green / = / 1z , / 3. Yellow City Applicant L� (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 f / o& V ' + ` L( ) 7r. l / SL LEGAL DESCRIPTION (office use only) LOT i 0 BLOCK 2- ADDITION £V , MNI PIDa6- 33,x- ©Za- 0 OWNER �,� // (Name) 0 17 CVJj(_ (Phone) ,5. �" - — b b ( 9 q:____ 4 (Address)' 1 0Ol'►'i 10 E1 c . J ��v 1� (1AL 553 7�- APPLICANT (Name) « ( i e (VO U `f" �Z hone) q�.: 4 { C /c) - ' 0 7 � �� (Address) / O - Ce 0 dc( nA 595 (Contact Person) J ht C 1 C ' (Phone) APPLICANT SIGNATURE / DATE / 0 ` ,.C/'// . l d APPLICANT PLEASE COMPLETE BELOW ❑NEW CONSTRUCTION ['REPLACEMENT ❑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 • vity ■G: . ty cal DHot Water into Required Side Yard Setbacks. • ❑ Radiation Fireplaces with Box Additions or Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings ❑ Vent. System then Devices Require a Building Permit. FIREPLACE MAKE AND MODEL Q3, ( _ _ FEE SCHEDUL Industrial, Commercial & Multi Family 1% of job cost Residential, Gas Fire e $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 1 $49.50 Cost $ Building Permit# A _ , ' HEATING PERMIT FEE $ 9-C` STATE SURCHARGE $ 5.00 ✓ , TOTAL PERMIT FEE $ 5 r-' ,57D (iiP II ,,r0 r • 0 This Application Becomes Your Building Permit When Approved / Receipt N � � p e Building Official Date MIMI By I 4 24 hour notice for all inspections (952) 447 -9850 4646 Dakota Street S.E., Prior Lake, Minnesota 55372