HomeMy WebLinkAboutMechanical Permit 04-0587
CITY OF PRIOR LAKE
REA TING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Ree'd
;~ ~:~ I PERMIT NO'04 ,r[>7/
). Yellow Apphcanl ~ 0
.,21ease ~ or Drint and sim at bottom)
ADDRESS
_147)2; Tlmt..;.ev(1d/+ Tro. rJ
ZONING (ollice use)
. LEGAL DESCRIPTION (office use only)
LOT d ~LOCK ( ADDITION
//./f26d.<'1. /i-t -a /J/.I~
pm.?? 5""3 S'3- 6J- 2(- ()
OWNER
(Name)
WCt:JrJ_dLX (.e
~/dNS
(phone)
(Address)
APPLICANT 0 ' r' I I I 1/\/"1/\
(Name) Irl r r /1 Y (Phone) "If" '2, - 1lJ-f-<...fLAAJ
(Address) J3E7 ,~fv.-hC?n Pt:tuG/ t!nd17l/C.,Y G6j:::y;L/..
. (Address) J ~. (City) (Zip Code) .
(Contact Person) &/ n _
APPLICANT SIGNATURE .. f ~ -rI, ~ OLV{~ DATE (tJ III / ()2.j
II ,~
APPLICANT P SE CO If'tE ~
FURNACE MAKE A 0 MODEL tj FUEL
FLUE SIZE RETURN~P IN'5~ T OUTPUT
TYPE OF SYSTEM 0 ~ATING OR POWER PLANT
" OWarm Air Plants ~ 0 Steam PLEASE NOTE:
OGravity ~_' 0 Hot Water Air Conditioner Units
o Mechanical 0 Radiation ' r Cannot Encroach into
OAir Conditioning ~pecial Devices VJI Y_,) 12(i Required Side Yard
OVent, System . JZf-OtherDevices J'<rar Setbacks
heCikr
FIREPLACE MAKE AND MODEL
Estimated Cost $
FEE SCHEDULE
1 % of job cost Residential, Gas fireplace
$39.50 minimum
$99.50
$64.50
L/O ,00
$39,50
Industrial, Commercial &. Multi-Family
Residential, Heating &. NC (New Construction)
Residential, Heating Only (New Construction)
Residential. Additions &. Alterations
Residential, AC Only
$39,50
$39.50
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
46. DC>
,50
Un,F,r)
ice Use Only)
fhis Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid tlO ,------
I Date t, ~(r; - L(
Rect,~y& 1
BY:i
V
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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