HomeMy WebLinkAboutMechanical Permit 12. 0429 / ._. 4/G r' 4 4- / -C0' I
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CITY OF PRIOR LAKE / Date Rec'd
•
t .�. HEATING/AIR CONDITIONING/FIREPLACE PERMIT
erl sdo- 1.Pink File PERMIT NO. I2,, 2_
3.YCipl f
1.Yellow Applicant
(Please type or print and sign at bottom)
ADDRES�Si ZONING(office use)
411�
431 l4C- 0iiel4— (11rc(e _s �
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name) /14 44-1-R oss,'ti, (Phone) 6./a--.25-6- .3.-C347
(Address) Li 73 1 �G�-e_c),..,
.0,-. (;e41e— S C
APPLICANT O1
(Name) ,. e 4h, t k� f! fie ' (Phone) /-�g�{-'7 7 g 8' •
Address 9-C es-@Caws. C. S V . 6164./4 $ Ct.( 5.371? .
(Address) (City) (Zip Code)
(Contact Person) p„t..........x (Phone) ! s —e --
APPLICANT SIGNATURE DATE 3 --0)-8 -la-
,
APPLICANT PLEASE COMPLETE BELOW
DNEW CONS CTION [REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL Y e 'r "e sS 4/ //1-/// -0 3 FUEL
FLUE SIZE 4> RETURN OPENINGS INPUT 70„.0i% 4) OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
[Warm Air PlantsPLEASE NOTE: Air Conditioner
0 Steam Units and Fireplaces Cannot Encroach
❑Gravity OrHot Water into Required Side Yard Setbacks.
Mechanical 0 Radiation
DAir 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) ,$664.5001 A� Residential,AC Only $49.50
Estimated Cost$ e �OD Building Permit #
/ The Minnesota Statutes*3268.148
HEATING PERMIT FEE $ 4.7. 6)0 "SURCI lAItfiye has been changed for one
near effective
STATE SURCHARGE $ i 3-,0 6 July I,2010.until June 30,2011.
TOTAL PERMIT FEE $ ( U — The minimum surcharge for a"Fixed fee"permit
(Office Use Only) 55,beginning July 1,2010
This Application Becomes Your Building Permit When Approved Paid Z Re pt No. �,S 175-
Date .. /(, .(2— B
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