HomeMy WebLinkAboutMechanical Permit 11. 0955 •
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rRlo CITY OF PRIOR LAKE Date ec'd
N �� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
18
INNEsisc 1.Pink File
2.GreenPERMIT NO. 7
—
3.Yellowcity Applicant N
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
35? Ser txce, -Tv- SLS/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWNE
L h I S..2 beu,N; .Q I Sur, (Phone01 ..— ---n350
(Address) 39,5 J ru e_191 10/i ,.- /JL/(Jf /4-0/ 6S37J--
APPLICANT (�
(Name) A .e • 1 • p— Phone) QS-2— .1," 2 )1
7(
(Address) 100 t.cQo (90 v 'a—it/✓C XYZ i rn 0 35 2.,
(Address) ' (City) (Zip Code)
(Contact Person) ' i (Phone) S� 2_1�.��
APPLICANT SIGNATURE �� DATE ______VS
;/
A'PLICANT PLEASE COMPLETE BELOW
E<EW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air PlantsPLEASE NOTE: Air Conditioner
0 Steam Units and Fireplaces Cannot Encroach
['Gravity 0 Hot Water
❑Mechanical into Required Side Yard Setbacks.
❑Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices
OVent.System 0 Other Devices Cantilevers to the Outside of Buildings
1 Require a Building Permit.
FIREPLACE MAKE AND MODEL aT t.G3r SUc E,Y —7-80 _
FEE SC
e1445 -------'----
Industrial,Commercial.&Multi-Family 1%of job cost Residential,Gas Fire la $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 $49.50
-`:._...-'.,`;ost$ Building Permit #
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended5�
until June 30,2013, HEATING PERMIT FEE $ l V
The minimum surcharge for a STATE SURCHARGE $ 5, 00 i
"fixed fee"permit is$5.00 COTAL PERMIT FEE $ 5t. - 5-0
This Application Becomes Your Building Permit When Approved Paid,..5y
y S v Rfrept No. lQ/ 0 j
Date 9 Z/, (1 1 ;y
Building Official Date / /
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372