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Mechanical Permit 13. 1279
- O O 0 000000 13 0» 2 A 0 0 0 C- Z B 0 m z m o § r R m m x - §kU z co -I � § J \ O � % § ®o a > § \ 7 � 0 > Z -I o \` Z --c- " M M 721 r 0 7 a § "u \ � � z , 0 0 / 00000 v-‘.-7 § § m m 11 cn ■® 0 § ° ° o -In m xC mxE m 0 ■ -11 2 / 2 i f m m § > 000 � o 3 0 0 tr § o z 2 § 2 - § 2 § CO r9 -a P < m ■ 0 n — r,;f- 73 § q & kr! k 3 o 0 00000 _ z » § » z �mm�§ - � o E . 0 "0 13 � = \ Z f ■ Ifl x � , �F k - � i 0 PR10 CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING/FIREPLACE PERMIT //, / 3 & U z o�P V 1. Pink File Ott NNES PERMIT NO. 2. Green City / 3 /2/ 7q 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) /qS8/ C/er, del /e. go e,0- u a T l &13 LEGAL DESCRIPTION (office use only) LOT ,2-- BLOCK g ADDITION 441( aj harh z ii4 /,4 Q,64/ PID / 1'5 - - /3 !jp -'0/3 —6) OWNER (Name) 7 ? f H___, It /?os a-K (Phone) 5 s.i - yi a - 8., ,c- / (Address) /KS Cs - /e a/ci /c 4!ie nrs c , 1 ;`o v Ia. fie h7 ,,✓ — 72 —. APPLICANT J (Name) a) u vr. / • 4 , S r v i c ms (Phone) y'.s"dl,) /7/0 'o 3 ° //1 l 6 (Address) f oZ 9 /eZ Vi°in, ,--.. L c� c c r 71 C� i t 4-P .Z 1 S / a iect / A S - 537y (Contact Person) $60-4 ge z. c (Phone) APPLICANT SIGNATURE DATE // -- //-43 APPLICANT PLEASE COMPLETE BELOW ['NEW CONSTRUCTION I 3 1 LACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL 5 9 m 4-0 � _ � I ,) 7 p �7 /y FUEL Aet, t* Q- 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 ❑ Gravity ❑ Hot Water into Required Side Yard Setbacks. W Ie chanical ❑ Radiation Fireplaces with Box Additions or it 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 $ 7 9/44 av Building Permit# HEATING PERMIT FEE $ '5/9%,5 STATE SURCHARGE $ 5.00 TOTAL PERMIT FEE $ 3 This Applicatio ! • com • Your : ilding Permit When Approved `i t ic"\. ,'D Receipt No. 7 ©4r ■ I ( ! Dat JJ By •.-•, Building a " cial ate 1` , �j • 24 hour notice for all inspections (952) 447 -9850 p � ) 4646 Dakota Street S.E., Prior Lake, Minnesota 55372