HomeMy WebLinkAboutMechanical Permit 15. 0294 Q.-.)
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O. ?Rip* CITY OF PRIOR LAKE Date Rec'd
E-4 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
U tri
�i, TP 1.Pink File PERMIT NO. 9
NNESQ 2.Green City /... .Z!
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
( O 07 a(fG►woord ho fcor (L
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Nam)R JGr Simony-)1 y-)( (Phoneg52 q22 b2tfcJ
(Address) 16097 I SOY f(f wood d Pd w Flol LaCv 55372
•
(NameAPPLICANT )'n V v�� ��V !ter�� J (Phone 1.`l J 5✓
(Address) 20267 COW(0(o 4/ 7 'v 5-03 )(1----- 5576f
(Contact Person) LU'ida (Phone)q q .�"cc7
APPLICANT SIGNATURE j2 DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
AKE AND MODEL p,1.��}Qj(�,j30 a7 tb km 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 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
IM'Air Conditioning 0 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 $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $ V01)
STATE SURCHARGE $_____ �.pp .,
TOTAL PERMIT FEE $ —
This Application Becomes Your Building Permit When Approved Paid 5V si3, Receipt 1\16L—
Building
. /_L
Building Official Date Date¢. 7_(5- Byp C_
24 hour notice for all inspections(952)447-9850 ^-
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372