HomeMy WebLinkAboutMechanical Permit 14. 0030 •
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of PRI% CITY OF PRIOR LAKE Date Reed
H HEATING/AIR CONDITIONING/FIREPLACE PERMIT
1.Pink File PERMIT NO.
INNEse' 2.Green City /+ 1—��
3.Yellow Applicant T
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
6Y /5-�- _7-v . /.^iee- �'/c'..:e. rill
•
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) % of e- £ X/2 e X''' (Phone) q 3-e,Z-G/Y 7-6'.2 ij--
(Address) _CQ hi -e
APPLICANT
(Name)
APPLICANT,
ere- /44 2/'Xce. (Phone)
(Address) e
(Contact Person) , (Phone)
APPLICANT SIGNATURE .... �' DATE //d/V ,
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
0 Gravity ❑Hot Water into Required Side Yard Setbacks.
0 Mechanical 0 Radiation Fireplaces with Box Additions or
0 Air Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
❑Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL'` ' o4 5 j A y toil-
FEE
SCHEDULE
Industrial,Commercial&Multi Family 1%of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&AIC(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
• im Cost$ Building Permit#
' HEATING PERMIT FEE $ s �C?
% STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE- $ fs (-2 v
This Ap+. a n Becomes Your Building Per i it W en Approved Paid Receipt No2,�-
/,. /i f r Dateii---
By
:u1 . - sae r24 hour notice for all inspections(952) 0
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372