HomeMy WebLinkAboutMechanical Permit 16. 0072 2oc000 0I 0 O
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o. vitro CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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JNNEsd t 1.Pink File
2.Green city PERMIT NO. /6, 7.2_
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRSS`E, 1 G �(' , ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
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(Naame)R bo .,, k c1 f\ra °Q, -ISd�3
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(Address) i I c)o -(,,‘,\(,\cc: r• -Tr- tnA
APPLICANT r\ 1
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(Name) cxAN- e'' (Phone) 9S a- kVC1 �` "1
(Address) \ 8 .)
16 � �,Ciel-NS\ b �Q �a 0•••J 4), S___c-ri�
(Address) (City) \ , i(Zip Code)
(Contact Person) ''\v1'‘.1 (Phone) C\—C. , `11-g\ak
APPLICANT SIGNATURE .:\ DATE \ D
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL 6r\) ( O‘OW 1\ FUEL N 11 T
FLUE SIZE RETURN OPENINGS INPUT ‘-%d) 0 1 ,0 OUTPUT 1*A 0
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
['Gravity 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation
BAir Conditioning 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 $49.50
Z.'..4..---a"cost$ Building Permit #
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended HEATING PERMIT FEE $
until June 30,2013, STATE SURCHARGE $ 1.60
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee"permit is$5.00
This Application Becomes Your Building Permit When Approved Paid 570 i sv Receipt No. iy�t2,1
Date/ �l'"�
Building Official Date l ?'1• L�'
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24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372