HomeMy WebLinkAboutMechanical Permit 09.0009 t 9 _ Cl ' LLr/' Jo• 09/1.- C_,OF i/PR/O4) ee740/ &✓� - O /
CITY OF PRIOR LAKE Date Rec'd
C HEATING/AIR CONDITIONING/FIREPLACE PERMIT / �Z
f .' 9
*iv ESO
I. Pink File PERMIT NO. 0009
3.Yellow City Applicant 2 GreenApplicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office
n
1-2a
-2 ^t 2 S, , to(,)02,65 7�4i L use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER `
(Name) ..JL��^ 1+00I (Phone) 9)2'y 7`.).,g6;I
(Address) ! Z Z ) E f/11 L)etAiO) ?Pi('
i
APPLICANT nn r ,�, r
(Name) F1 itL.,5 ! DL. 10..NrM : liovi L (Phone) (O6 1— Co 33-lo4 2_
(Address) f o o FA'l v t L tt‘/l.s 'J 1 P.osa 1 a lit(J - ! /3
(Address) (City) (033-(Zip Code)
i(Contact Person) b C 0 (Phone) (.0E f` 1 04
4
APPLICANT SIGNATURE DATE
APPLICANT PL ASE COMPLETE BELOW
['NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants D Steam PLEASE NOTE:
['Gravity D Hot Water Air Conditioner Units
D Mechanical 0 Radiation Cannot Encroach into
DAir Conditioning 0 Special Devices Required Side Yard
DVer_t.System El Other Devices Setbacks
FIREPLACE MAKE AND MODEL J45-/i'(r(0 &WO-a 41V,A' 15
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace ....$497513-
$39.50
S39'S6$39.50 minimum
Residential,Heating&A/C(New Construction) $99.50 Residential,Additions&Alterations $39.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $39.50
Estimated Cost$ Building Permit #
HEATING PERMIT FEE $ #9, 50
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 50. 0 v •
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No. 5,7206-
Date /Z. O 9 By
pi--
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245