HomeMy WebLinkAboutWater Heater 13.1264 ; 0 07k 0 000000 E. n
o
A n n 0 0 K q g m 2 m
o > o m c o m m m n o
• § k 2 ' � E kkk • 0 2
z o z 0
q § i� & § ...1 0 Z @ ( z §
Z �k
� � � � � Z �
\ o A > k '-
§ ■ r o
o X 73
m 73 o
QOQOO
41 m �m m ill a '0 ■ *■"0 PI
§ § o o ocl»oc &
$ 2 f m 0 ii. ■
m ° 2 ■■ ■ kk� � @ 0 i
en ▪ 0 2 . ��22 - E
m
o # m r 11" P - §
/ =
0
m
o n
o �
. m 000000
§ ... § _z20§ c- � §
o 1_ § '0 "0 ...,1 % zo & c ; ; § .
9 rn , q %
31 E E §
kA §
01 r Rrp + CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT 1/ g /3
rn �� Q2 1. Pink File PERMIT NO.
INNESO 2. Green City
1 /? / iz
3. Yellow Applicant
!/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5'070 6,sad ®yv_' 5 S8 f r i v✓j,a 0.1„ 5'537 -.7 R/ SL
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION Ce 0 ,1y5 62 42,... PID , -O2 06-0
OWNER
(Name) / f ,�y�
) te jOe- 6- 14 Ye (Phone) Z /2 eZ, 7 31)1
(Address) 507e) 7 (,2 s , ..vS s SE L214 1,kC !off X5 37 -2 -
APPLICANX? /
(Name) l_- - /vet- /3-C. ,4 i 1 (Phone) 1.7 1 V1-1,- V 4'
(Address) 7 '{L , 0 7 ki 4 S 4 i`Yr ,c S d de .-) 1^e- / - t :, h'd ss vs/
(Contact Person) e. r t-k (Phone) ) ---C3? — 1�' •�S -?a,,'
APPLICANT SIGNATURE it iliWrAWM. DATE 11 ‘ `
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION [REPLACEMENT ❑ALTERATIONS /
FURNACE MAKE AND MODEL -S # l FUEL E / _ o'' `
FLUE SIZE RETURN OPENINGS INPUT 300,e>O OUTPUT ,g e$`413 b
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.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
❑ Air 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 Residential, AC Only $49.50
Cost $ Building Permit#
HEATING PERMIT FEE $ 1 1 .50
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ �C/ , ��e>
This Application ate Becomes ur Building Permit When A roved ; . �! L, /�, ` Receipt Nor 3q
ti II .. C4, �� Ty "I ,(b
Buildin fficial Date tt (' l O� By
((
i
g `—� A
24 hour notice for all inspections (952) 447 -9850 ✓✓
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
u
■
■
■
■
■