HomeMy WebLinkAboutMechanical Permit 12. 0919 Li, lz. A9‘/ 0566
4 rRIO CITY OF PRIOR LAKE Date Recd
4,11 ike HEATING/AIR CONDITIONING/FIREPLACE PERMIT
e:Z7,ce ) 7Si)elift--Z 440
INNESD�P is Fink
r en cis>, PERMIT NO. ^J 9
3.Yellow Applicant �� /
(Please type or print and sign at bottom)
ADDRESS /72, `L` ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) d„.,-rii ciA0 (Phone) •
f
(Address 21
EARTH & HOME TECHNOLOGIES, IN
APPLICANT dba FIRESIDE HEARTH & HOME CE
(Name) Lic. BCOS12060 (Phone) •
2700 FAIRVIEW AVENUE N
(Address) ROSEVII I F MN 55113 •
65(I:165 3.2561 (City) (Zip Code)
(Contact Person) ktri
[� (Phone) 10 12-—3 G 3—2.17
APPLICANT SIGNATURE /Z ®/7-.7G O'i._._- DATE �0D'f?—
APPLICANT PLEASE COMPLETE BELOW •
ANEW CONSTRUCTION ❑REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air PlantsPLEASE NOTE: Air Conditioner
El Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water
Mechanical CI Radiation into Required Side Yard Setbacks.
DAir Conditioning El Special Devices Fireplaces with Box Additions or
❑Vent.System El Other Devices Cantilevers to the Outside of Buildings
�
hT/ Require a Building Permit.
1 FIREPLACE MAKE AND MODEL NOV 3/332 ie
FEE SCHEDULE
Industrial,Commercial&Multi-Family I%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 $49.50
Estimated Cost$ I c'O'a Building Permit #
The Minnesota Statutes*32613.148
� "SURCHARGE.;"has been changed lilr one
Li HEATING PERMIT FEE $ )U year effective
STATE SURCHARGE $ ' 0 .5,0 July 1,2010,until June 30.2011.
TOTAL PERMIT FEE $ j ttf, 50 the minimum surcharge for a"fixed fee"permit
(Office Use Only)
is,$,J5,,beginning dtdy 1.2010
This Application Becomes Your Building Permit When Approved Paid j z Receipt No./ /' 77�1
Building Official Date Date (�J43/L By /� 4
24 hour notice for all inspections(952)447-9850,fax(952)/ 447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372