HomeMy WebLinkAboutMechanical Permit 09.0788 3 0 0 0 C') ❑C1❑000 "3 O a ZC)
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C1NN'Rio, CITYOF PRIOR LAKE Date Rec'd
; HEATING/AIR CONDITIONING/FIREPLACE PERMIT
x
t=iEso° 1.rink File PERMIT NO. 09 0 77 6
2.Green city D
3.Yellow Applicant
(Please type or print and sign at botto�m)
ADDRESS ZONING(office use)
14laq(o `kr:e y000d (load 0
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Eli 1' 1 Zr aY\1 col-1-59-3
(Name) ''vv (Phone) ��'
(Address) 14 q53 k Ms vo IV 113
APPLIC
(Name) nS Wedh 1,0u
, t{C. (Phone)
(Address)
(Address) iWIO OeC1 —e)T\CY.._ Upord I1coo(
fttop.42b6
(Address) (City) (� (Zip Code)
(Contact Person) Lkfldw., "l5
(Phone) - LILtS'QOS
APPLICANT SIGNATURE tr I V ti\IDATE —faq"LJ_r
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION PLACEMENT ❑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 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation
❑Air Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.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 $ Lt"l•)
STATE SURCHARGE $ 50
TOTAL PERMIT FEE $ 50•
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid,O ,no Rec- , No.5sq E5-3
Dp- Q !. oci
Official Date
By4
24 hour notice for all inspections(952)447-9850,fax(952)447-42145
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372