HomeMy WebLinkAboutMechanical Permit 12. 1490 �r t0 \\
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CITY OF PRIOR LAKE `� Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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1.Pink FileCity PERMIT NO. /J i f�-��O
3.Yree /L •-• / /
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office
I,S Z —2 Fr X31 45 I !l''' /()( use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERt L i' - R.() O / J1 L
(Name) (Phone) 2 —735"01? b
(Address) i•CI U) FY) t g-3/i-P) N /L.''
APPLIC(Name)ANT r(ItL 5 l OL 1� I; N (Phone) �p J` -L073- 3301
(Address) )00 FALP-u10--) Ao& a a3stsutt-A.0T IAN 531l,3
(Address) (City) (Zip Code)
(Contact Person) () ) j'i _r_,__ (Phone) (O (j3 9 3305
APPLICANT SIGNATURE /rDATE G 24 11)1/Z
LICANT PLEA E COMPLETE BELOW
❑NEW CONSTRUCTION ❑REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants ❑Steam PLEASE NOTE:
❑Gravity ❑Hot Water Air Conditioner Units
❑Mechanical ❑Radiation Cannot Encroach into
['Air Conditioning ❑Special Devices Required Side Yard
OVent.System .❑Other Devices Setbacks
FIREPLACE MAKE AND MODEL/U'U'U) l)Li c) 1 /...1,0-5(../2-
FEE
'",0"5(..2FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace $39.50
$39.50 minimum
Residential,Heating&A/C(New Construction) $99.50 Residential,Additions&Alterations $39.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $39.50
Estimated Cost$ Building Per it #
HEATING PERMIT FEE $ - k9-ro
STATE SURCHARGE $ •5
TOTAL PERMIT FEE $ 9-1
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ,co Receipt No. • 76, /
Building Official Date Date/ , / %//� By J �
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24 hour notice for all inspections(952)447-9850,fax(952)447-4245