HomeMy WebLinkAboutMechanical Permit 10. 1089 of PRION ,
CITY OF PRIOR LAKE Date Rec'd
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS1 b 961 6 C j a rk L w ) c E use)
(office
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LEGAL DESCRIPTION(office use only) `J
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v 774 I'
LOT BLOCK ADDITION PID
OWNER
(Name) 1 " \ V I' LL C24'Lt4 (Phone) I b 3..Lfq 0- ('T o
(Address)
AP
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(NPamI)ANT /� /J 1h (Phone) 1(U 3-'11 0- 00 if
(Address)i I!j t i live„ U Nei+�w 1�N 553'ir
(Address) (City) (Zip Code)
(Contact Person) 14 T C (Phone)
APPLICANT SIGNA DATE 1 1 I l b//U
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION�/ ,REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL V All- -- -7-611C 0 611,W I FUEL N LI Q.
If
FLUE SIZE Z RETURN OPENINGS INPUT ( 12 00 0 OUTPUT 55 J CV O
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
'-':Air Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System 0 Other Devices 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 $49.50
Estimated Cost$ (Ji Doo% Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ Sli.SU
(Office Use Only)
This Application Becomes Your Building Permit When Approved I I Paid,„.--, / 7) I Receipt No.
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