HomeMy WebLinkAboutMechanical Permit 13. 1278 J
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r RIp CITY OF PRIOR LAKE Date Recd
ti ,c HEATING /AIR CONDITIONING /FIREPLACE PERMIT f/ l )3
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ln'NES0° 1, Pink File PERMIT NO .
3 , Yellow City / f 7 �S(
3. Yellow Applicant / UU
, _Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 5 (5 )LI Jeff Pas •/
LEGAL DESCRIPTION (office use only) /
LOT q BLOCK I/ ADDITION G � /2LS L Ni , 25- . 3g' JZ)e 2 . v
OWNER ► ` Mo( k o C G 1 Z ZJ2'V me) �� C` (Phone)
(Address) ) 5 J ) l.) affcr s ?Q S S
(N ANT f' , y , IA Z an (Phone) 9S Z : 7(i7 - 160 V
(Address) 2 •0 Hu.y, \ 3 B L S' ( e 5333
(Address) (City / (Zip Code)
(Contact Person) N.A. (Phone) L� L' —/ 00 V
APPLICANT SIGNATURE By�CX DA 1 1 I
APPLICANT PL AS COMPLETE BELOW
ANEW CON ' UCTION PLACEMENT (� ❑ ALTERATIONS
FURNACE MAKE AND MODEL ;W.; Cctr r I cx' J°9 i'1 7 AU 8 0 V Ih FULL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
QWarm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
�[�t rravity 0 Hot Water into Required Side Yard Setbacks.
Mechanical 0 Radiation
DAir Conditioning 0 Special Devices Fireplaces with Box Additions or
DVent. 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 r
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 4
The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ q9 . S 0 "SURCHARGE" lARG has been changed for one
year effective
STATE SURCHARGE $ ,Q .50 July b, 2010, nutil dune 30, 201 L
TOTAL PERMIT FEE $ 51i $U The minimum surcharge for a "fixed fee" permit
(Office Use Only) is $1, beginning July 1.2010
This Application Becomes our Building Permit When Approved p " ' 1 . e S Receipt No. 1 ® ""
—1 2_
t '3 : 13 Da B
"'Building I I 1. ,' 3 By SA-
icia Date
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24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372