HomeMy WebLinkAboutMechanical Permit 10.1044 tA1
0-503 CITY OF PRIOR LAKE /(94 Z /2`1 Date Rec'd
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,� HEATING/AIR CONDITIONING/FIREPLACE PER&II I' , 0,10
�rj SQ. 1.pink File PERMIT NO. 0 10�
N1VE50 2.Green City
3.Yellow Applicant TTT
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
37c15 Truk 4ot C+. KW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OR ��e `„ 2I2ALL (Phone)
(Address) 1T- Qti- C+) 1 v 1 v
(Name)APPLICAN ' ' p °15 1 , kp
(Name) 11 b)tos\A1,(Phonen(Address) '1, 'o \ i� CM S 3-7
( ddress) (City (Zip Code)
(Contact Person) (Phone) ( ;- 1 t��..L�- (1J'J v
APPLICANT SIGNAT . ..�� 1$ I���lA r ' 1444 -- I \ V i
I
A'PLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION ❑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 Fireplaces Cannot Encroach
['Gravity 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
❑:it Conditioning 0 Special Devices Cantilevers to the Outside of Buildings
` Vent.System i rn ❑vices
e -=�rCCJJ i $ I t 1 4 5"YY� W &U -� Require a Building Permit.
FIRE'LACE MAKE A' D MODEL �p
Cove.lr er& l 'r"jX k
. „�c�4--V CtM �cLL IAA-0,-v-k-N)J ..C%J .
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 $ 4- ,s-1)
STATE SURCHARGE $
TOTAL PERMIT FEE $ 5 LI <
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(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 514/,VD l4ceipt Nob(G („
Date 1 /y
Building Official Date 4 ( '
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372