HomeMy WebLinkAboutMechanical Permit 12. 0980 '5000
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V?R10 CITY OF PRIOR LAKE Date Rec'd
°ti ` : IDEATING/AIR CONDITIONING/FIREPLACE PERMIT
°'jNixxsofit' 2.Pink
em c PERMIT NO. /L-Q 9 f()
3.Ycllow Applicant
(Please type or print and sign at bottom)
ADDRESS • ZONING(oftic use)
4 (2 / 1/sem e' %,/ s
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) • 5c‘.. Sj '�-c- 7 (Phone) Z,.'/--- �7-.,
/�
(Address) 7 52/ / LV e c.- 7,'- -i 5,-7', ..•c' '�l<, ,5--.)3J�
APPLICANT
(Name) _xGt`i -e--" •,• "�,•,,4 5/ hone �.5�-
(Address) G9 4-2 ,d✓- i le......�y Sim , ��r- Q. ' .5 .5S-i
(Address) (City) (Zip Code)
(Contact Person) ------",."-/-
"/ 0- h .64.-e•-- (Phone) 5�) - -.3-.7'y'-9
APPLICANT SIGNATURE ,.........00V--.2-...-- E DATE --- .3 /L-
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 0 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 Fire laces Cannot Encroach
❑Gravity ' " 0 Hot Water into Re p
❑Mechanical 0 Radiation quired Side Yard Setbacks.
❑Air Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System R.-Other Devices 6-.-5 -<-'s2 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 $49,50
Estimated Cost$ 5 �' Building Permit #
HEATING PERMIT FEE $ ,,-'
STATE SURCHARGE $
TOTAL PERMIT FEE $ r'7'71-c'---- 5X5 Z
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid s-1/.,
--y Receipt No. j 9
Bulldine Official Date Date �/J11/� By ,
24 hour notice for all inspections(952)447 9850,fax(952)447-4245/
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372