HomeMy WebLinkAboutMechanical Permit 14. 0381 0 J
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o, FR/0 CITY OF PRIOR LAKE C../ Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT 5 /6. /4
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�� 1.Pink File PERMIT NO.
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NNEso 2.Green City j oP
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 1 ZON G(office use)
3 444 63, Uv,`l�0k.v l csi_L - \ /
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION 74eier -6----- 16744--33 PID R5- /a6 -0/e_4
OWNER
(Name) 6751Ctr cit (g L&Ct-tt. (Phone) &(1- 7 70-533 /
(Address) 34/4/6 Wil/1 t b'v— 16•CcAC , 1"C .
APPLICANT
(Name) f `tr X II U NNIQ:-. (Phone) 6/Z. 6,e` e/
(Address) a O C 5 J i j • i`
(Contact Person) W.A.,- ( 7dc`'ti0 (Phone) i' - 5 7.,8(Z
APPLICANT SIGNATURE DATE 5-- / --- /"
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ['REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
0 Air Conditioning 0 Special Devices i i Cantilevers to the Outside of Buildings
0 Vent. System -1.... MOther Devices S fav C/6 't'l l Require a Building Permit.
FIREPLACE MAKE AND MODEL Ga.s ii`ne fa r 3 ov+ Sete Gr Pi f
FEE SCHED LE
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 $ 9 ' -
STATE SURCHARGE $ 00
TOTAL PERMIT FEE $ Tr& Q
This Application a omes Yo uilding Permit When Approved czN re ida .S ::ct
eipNo. /a/
Building Ofic' Date Dat5 t/`�1 , A
24 hour notice for all inspections(952)447-( ` /:
98850 �
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372