HomeMy WebLinkAboutMechanical Permit 12. 0446 I,L ,/4 C-1.03
4PRIO3 CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT C
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1NNESo�P I.Fink File PERMIT NO.
2. Green City /� ` 4,4_.(o
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(NaOWNme)
���� '�(1' �' (PhonerIS 5440(0 13
(Address) 5049s 9(s-,d,S�e Ln I -rri cs - ku-, al 1\) 55 3--)a-,
APPLICANTi
(Name) ��' ,' \--\— r4\ d---\A13 MQ (Phone) -Q
S' - Ca --X-1
(Address) I by \ OY a-CCIC0 b�(�'' JOcfC DO V\ 1 P1 N) 65 35
(Addre (City) Q (Zip Code)
(Contact Person) i 1 C (Phone) °n0/, _L.�. - 19�7 (tC3
APPLICANT SIGNATURE0)..- DATE 5/ /0 / 2-
PLICANT PLEASE COMPLETE BELOW
:NEW CONSTRUCTION ❑REPLACEMENTERATIONS
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 ❑.Hot Water
Mechanical into Required Side Yard Setbacks.
0 ❑Radiation
:kir Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System 0 Other Device Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL J2N) e 10I 119
FEE SCHE i .
Industrial,Commercial&Multi-Family 1%of job cost ' -sidential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&A/C(New Construction) $149.50 :. . :. • era ions $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Estimated Cost$ Building Permit #
The Minnesota Statutes§326B.148
HEATING PERMIT FEE $ F S-0 has been changed for one
STATE SURCHARGE $ year effective
TOTAL PERMIT FEE $ , y-, SID The minimum surcharge fora"fixed fee"permit
(Office Use Only)
Is ,,beginning July 1,2010
This Application Becomes Your Building Permit When Approved Paid s�Z.) Rece. No. &5-7q2_,'7 q�
Buildine Official Date Date 6—` / _ ! B •
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372