HomeMy WebLinkAboutMechanical Permit 15. 1314 J
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o� Rt CITY CITY OF PRIOR LAKE Date Rec'd
A, PERMIT
HEATING/AIR CONDITIONING/FIREPLACE .
H
1,jA'NESO i.Pink File PERMIT NO. �� 2 (
2. Green City J
3. Yellow Applicant L
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5e3,5 S53"70.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER /� f (� /¢1
(Name) Q. 1 f�r << 4 (Phone) / 5c 445" J O/
(Address) -- 30 -
APPLICANT
(Name) IIn e)
(Address) 12850 Chestnut 81vd.
(Ad.ss) hake p, MN 55379 (City) (Zip Code)
I 952-445-4603
(Contact Person) 'NI ,. ;r / (Phone)
APPLICANT SIGNATURE 111111/M° DATE `Or
A `PLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION tR.EPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL 5 9-r-P&A-ab E)7-!¢ Oa 1'Tt€V FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
❑Gravity ❑Hot Water Units and Fireplaces Cannot Encroach
■ echanical ❑Radiation into Required Side Yard Setbacks.
Conditioning " ir�ch 0 Special Devices Fireplaces with Box Additions or
V ent. 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 $49.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ c5C,t d
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid a Receipt No.
Date By al._
Building Official Date `V- 2�'
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372