HomeMy WebLinkAboutMechanical Permit 11. 1291 ,».
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I l I I -731 $501----
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E CITY OF PRIOR LAKE (� Date Recd
° ,; HEATING/AIR CONDITIONING/FIREPLACE PERMIT
414.11000 RiletyNO/1y_,
/(PERMIT NO / 9/
2,f3rcea Ci /��'
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
k 0)4 Aev i.o..l t A.le 5
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) "cep-crxc'a "tJ.m t,c‘n opr')o(W.. (Phone)
(Address)
APPLICANT
(Name) 'moo,-'-oz_ NhecJr,o3 U A\ (Phone) --fkj73-5 -1Z-\'LDU
(Address)spk9OICY2 . 1-C.. (�()Win�0-,A)1 q`-/\‘ kap
(Address) (City) (Zip Code)
(Contact Person) uCe.._ (Phone)
•
APPLICANT SIGNATURE _L.111.A DATE l / "I
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 0 REPLACEMENT ALTERATIONS elan t
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING.OR POWER PLANT
❑Warm Air Plants 0 Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation
❑Air Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System ❑Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEESCHEI 1- - •
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 $49.50
Cost$ d Building Permit #
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended HEATING PERMIT FEE $ 4 •5b
until June 30,2013, STATE SURCHARGE $ 5iL
The minimum surcharge for a TOTAL PERMIT FEE $$—?°747.
"fixed fee"permit is$5.00 �' • �6
This Application Becomes Your Building Permit When Approved Paid 7 I-� Rece' No., ,17L
Date Z
Buntline Official Date 2 By
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372