HomeMy WebLinkAboutMechanical Permit 12. 0495 ri‘P
RIOTCITY OF PRIOR LAKE '%41,(8-c ,n .� Date Rec'd
HEATING/AIR CONDITIONING/FIREPLA E PE ' I 1-�' ' ca
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1.Pink
File PERMIT NO.
2.Green City
3.Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESS (61( ZONING(office use)
Skjee0 6fite-4 g S,I)J
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNE((Name) 1?OV3 fit) /<'rZ I i i hop (Phone) 95.1-4/W--606-.
(Address) 3S(2S i�JY9,S dvb u,„Pi `L Si a
l
APPLICANT9 ,�/
(Name) 1 /(Phone) l?� ��u �'7
(Address) _1701Millr, 0� 1 1 di. i 5 14
(Address) (City) (Zip Code)
i�pp'�pp 0
(Contact Person) 211v (Phone) &T"6 S--
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APPLICANT SIGNATURE / DATE
APPLICANT PLE�A.,S�COMPLETE BELOW
❑NEW CONSTRUCTION L"7 REPLACEMENTALTERATIONS
FURNACE MAKE AND MODEL "gig AJ& i GJI4Q) f5 A 24,101-*
FUEL ( (iW1A/6
FLUE SIZE lial ni,lirixt 1 VkETURN OPENINGS INPUT Wfay OUTPUT 7//
• TYPEFF SYSTEM HEATING OR POWER PLANT
arm Air Plants II$I&t !?i91/1'tG 0 Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
❑Gravity
0 Hot Water into Required Side Yard Setbacks.
❑ echanical 0 Radiation
Air Conditioning IQI 1,/I1U 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 $49.50
The Minnesota Statutes§326B.148 ._-1 Cost$ Building Permit #
"SURCHARGE”has been extended � 61,until June 30,2013, HEATING PERMIT FEE $ "7-/‘
The minimum surcharge for a STATE SURCHARGE $ , .35
"fixed fee"permit is$5.00 TOTAL PERMIT FEE $ , 5,0
This Application Becomes Your Building Permit When Approved Paid 6.27(ro Re No.6 ceps-77
Date - 247
/...z.i
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 i '
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372