HomeMy WebLinkAboutMechanical Permit for 10.0150 �� PR 10�
CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
filo'E SOS
2 I. Pinkreen Piilery PERMIT NO.
G
0 150
3.Yellow Applicant 5 O •
(Please type or print and sign at bottom)
ADDRESS JV � ZONING(office
ILlVf�'y 0 il�vl 5 7 "'wi d r use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �/
(Name) KC-17)-1 70L'J (Phone)
' (Address)
A(IPPLtI jANT F`fl► ✓ 1 IJ S 1 .(M1,-1� : )4001 L (Phone) (05-1- 03- 10'1 2_
(Address) f o FAL i 11--1 i L F\1 /J ' SE V l U,.- Iki ' 1 /3
(Address) (City) .. (Zip Code)
(oE Z.
(Contact Person) ;' 4 (Phone)
I- (033—10L!
APPLICANT SIGNATURE 411r.itir
'� '' DATE _____34_1_k
APPLICAN WLEASE COMPLETE BELOW
ONEW CONSTRUCTION ❑REPLACEMENT El 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 0 Special Devices Required Side Yard
❑Vent.System ❑Other Devices Setbacks
FIREPLACE MAKE AND MODEL IVI /7 e 5 CAPL-: 3 b1AJ
FEE SCHEDULE co
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace g ` 41
$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 Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid5Q QQ Receipt No—9b?7
Date j5 ,( 0 B, 7
Building Official Date G
24 hour notice for all inspections(952)447-9850,fax(952)447-4245