HomeMy WebLinkAboutMechanical Permit 12. 0933 (2) (.-'"'"pR1:0,-- CITY OF PRIOR LAKE Date Rec'd
� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�N1VEs° PERMIT NO. t/
2.Yello City /...2. —/� 933
3. Yellow Applicant (f /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/go 33 C o pi m e)CD,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT' ( �^ -7-366-314 (
(Name) `Q r 11 (r 61 y (Phone) (.C�/v-
(Address) 3 5552 "eh S f 7 n 5'E 5g9 4 03-A 44 -1
(Address) (City) (Zip Code)
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(Contact Person) i2 4 r , /1 e t/1 (Phone) 6 0.--366 3 hi
APPLICANT SIGNATURE Ji f /,_ ' 0�f /_A ' DATE _0441_2_
APPLICANT PLEASE COMPLETE BELOW
ENEW CONSTRUCTION .+: ' PLACEMENT� El ALTERATIONS ,(
FURNACE MAKE AND MODEL /�cA a d .�667' / ®� FUEL pe gags?
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air PlantsPLEASE NOTE: Air Conditioner
0 Steam Units and Fireplaces Cannot Encroach
['Gravity 0 Hot Water
❑Mechanical into Required Side Yard Setbacks.
❑Radiation
[kir Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System 0 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
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
The Minnesota Statutes§326B.148 =ost$ � Er*O Building Permit #
"SURCHARGE"has been extended
until June 30,2013, HEATING PERMIT FEE $ ,51®D
The minimum surcharge for a STATE SURCHARGE $ '5 D O -:519—
"fixed fee"permit is$5.00 TOTAL PERMIT FEE $ b1/43 40
kutnce use uniy)
This A cati' n c es Your Building Permit en proved
This g i� ® Receipt No. / / 177.t
'� ��
Date Date V/57/2 Receipt
1
By
Buildine
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372