HomeMy WebLinkAboutMechanical Permit 14. 0351 n OD000O 19 v 0)/
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CITY OF PRIOR LAKE Date Rec'd
` - HEATING/AIR CONDITIONING/FIREPLACE PERMIT
x
,-/NNESO 1.Pink File PERMIT NO.
2.Green City j�
(Please type or print and sign at bottom) 3.Yellow Applicant �/
ADDRESS f L+Lis 1 n
ZONING(office use)
` br2 N b-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNE(Name) d— 4\,� �®ameI.,
r� [� (Phone) � .- # � .`
Address Cir. �� '
`\ 'en. • ._.' M 1 SS _-
APPLICANT +41\
(Name) ��_ si� I (Phone) 0,� I
(Address) v* /
(Contact Person) v� I -
(Phone) .-
APPLICANT SIGNATURE �/ � r
at
__5fij,/t_________
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ['REPLACEMENT
FURNACE MAKE AND MODEL 1 ALTERATIONS
FLUE SIZE RETURN OPENINGS FUEL
TYPE OF SYSTEM INPU OUTPUT
HEATING OR POWER PLANT
O Warm Air Plants 0 Steam PLEASE NOTE:Air Conditioner
Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water
❑MeMechanical 0into Required Side Yard Setbacks.
Ohanical in Radiation
g ❑Special Devices Fireplaces with Box Additions or
❑Vent. System ■Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL LRequire a Building Permit.
FEE CHEDULE
Industrial, Commercial&Multi Family 1%of job cost /•esld�as Fireplace
Residential,Heating&A/C $49.50 minimu�• $49.50
Residential,HeatinOnly(New Construction) ) $64.50$149.5Residential,AdditionsCly &Alterations
Residential,AC Only $49.50
$49.50
Cost$ Building Permit#
HEATING PERMIT FEE
STATE SURCHARGE $00'_'
TOTAL PERMIT FEE
This Application Becomes Your Building Permit When Approved Paid
74[�1) Receipt Na /2.4i
Building Official Date Date row/ By
AMIll
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372