HomeMy WebLinkAboutMechanical Permit 13. 0072 a''. 1,1(), CITY OF PRIOR LAKE Date Rec'd
� HEATING/AIR CONDITIONING/FIREPLACE PERMIT 1,t)/ �/b
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j-'NEso. 1.Pink File
2. Green City PERMIT NO. /,3 _0 72—
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS -'–
ZONING(office use)
(e OD -��if � Ski T LSC
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERI1
(Name) (0 6 Ley_ 6i., 10,A.A., v1 i'd (Phone)9s-- -ezi6.9P-Z4o-a
(Address) !/0 La olly vePice V/(-C �'/ i" 556,1v
APPLICANTj`, ��
(Name) -/ I Uw)/IC, 4— r� E one) ✓, `� .F Ai°
(Address) _ i /J'IL /' A _ // i SL
S3
JtAfik,A
(Addy (Ci ) Zit Code)
(Contact Person) Pi (Phone) � ._- '
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APPLICANT SIGNATURE A DATE //e729.1/ 3
AP ICANT PLEASE COMPLETE BELOW
•
['NEW CONSTRUCTION ['REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT '
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gr vity ❑Hot Water into Required Side Yard Setbacks.
echanical ❑Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices
❑Vent.System I=1 Other Devices Cantilevers to the Outside of Buildings
I /� / Require a Building Permit.
FIREPLACE MAKE AND MODE j 02 /H , 7b/-491-5 ��
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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 $49.50
The Minnesota Statutes§326B.14.8 dost$ Building Permit #
"SURCHARGE"has been extended (�y
HEATING PERMIT FEE $ L
The minimum surcharge for a STATE SURCHARGE $ t"
"fixed fee"permit is TOTAL PERMIT FEE $ _ ,ah
— t MP
This Application Becomes Your Building Permit When Approved Paid sii\rt Receipt No. / to 44-
Date I/ / By
Building Official Date /
ci,
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372