HomeMy WebLinkAboutMechanical Permit 04-0296
CITY OF PRIOR LAKE
REA TING/ AIR CONDITIONINGI ~ lKEPLACE PERMIl
1. Pink File
2. Green City
3 . Yellow Applicant
Date Rec'd
(please type or ...&~t and sign at bottom)
ADDRESS L ~
\4030 c.Dx~\e\.~ ~ ,J~
PERMIT NO. Ot{" A;ib
zopr; S~U2)
PID J5 -~/6.- 003-tt>
(Ph~- 4Qlp-ILf~
L. EGAL DESCRIPTION (office use only) q ...
LOT ~ BLOCK l ADDmON ~
o~ qU^
OWNER
(Name) fur-t"Dl t=e.~~
(Address) t4(}~) rac-<1..\.B . ~ G, t-Jt...
APPLICANT . .. a ~h.
(Name)GX't\\ero ~\ l~\de D
(Address) /dJ3:J W. J4&'~t . .-=1#=- J~
(Address) ,
(Contact Person) D:J...r'\ ~\~
".-,PPLICANTSIGNATURE a~ ~~
..
(Phone) ~-t.i3\-..-,cqq
ar:pte~ I "eJ II~, \ !jSla'-l
, (City) V (Zip Code)
(phone) Cf5~-4~)-~q
4-16-0-1-
DATE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION fJ REPLACEMENT 0 AL IbM TIONS
FURNACE MAKE AND MODELCor-r\~.r S,R tl\\fPCl.or\-ILI FUEL tJ CLtu.raJ
FLUE SIZE S II RETURN OPENINGS INPUT t..n~ OUTPUT
nJ:"~OFSYSTEM HEATING OR POWER PLANT
DWarm Air Plants
iravity
echanical
. r Conditioning
r. :JVent. System
\..-\...1 ~ 1'\'
PfR~~l J. CE MAKE AND MODEL,-CJ..rr\ er -
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
fila Tal- 3 RT2Aa\ g
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ 0.3COe:p
,
Building Permit #
,~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERl\'.u.. ~ EE
$
$
$
3Q. f::JO
.50
uD~
flee Use Only)
Building Official
Paid c/O,./'
Date '-! -IC} -I.{
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
This Application Becomes Your Building Permit When Approved
Date
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Receipt NUfo t/1d
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CIW. PRIOR tAKE
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ADDRESS JC{Q.lo
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PHONE NO.' .
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DATE
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SCHEDULED
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_IT NO.
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o PLUMBING RI
o MeCH RI
C WATER HOOKUP
", '~"'S1MER HOOKUP
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.,~'NAL
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o EXlGRADlFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
C GASUNEAJR TST
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o COR CALL FOR RElNSPEcnON 8U."~'NG_.,
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lnspedo Owner/Contr:
CA "~...6R 'nt&aIix.T fH8r..:v..o. 24HCitJRs IN ADVANcE.
~REMENT$ AIlE ~R YOUR PERSONALlIEALTH & SAFE'I'Y;
D..~ .- J ~
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