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(please type or print and sign at bottom)
I ADDRESS
51 Q Y ~-' ~.. '::::C-
CITY OF PRIOl THIS FILE HAS BEEN
HEATING/AIR CONDITIONIN CLOSED DUE TO
INACTIVITY 4/16/2008
REQUEST FOR l'u~r\.L
INSPECTION SENT TO
HOMEOWNER 10-06
Date Rec'd
~J~icanl I PERMIT NO:s: 1/14- I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z<:;'. 0)0. OCP.-, I
OWNER \.- ...... _ L\
(Name) p~ ,; \ J:j-<-J...1 Tl'~
(Address) 5\" J 4-\C+:e-, '.:::5\- Sb
(Phone) fo' ;}-..3.;;:}8-3\ k9
APPLICANT
(Name) Lo") ~\Q.r~ ~O 1+1-5; dv+l!J '
(Address) LoQ~~ lJj .lq~-!:b..6t-" -#= 1CLt,
(Address)
(Contact Person) ~ ~
APPLICANT SIGNATURE (!Jh ~L
(Phone)
CfS;;:l.- Y3J-7C4Q
...55 J ~
(Zip Code)
-LJ 31- ?J{Jq q
II-~-E.:JS
o
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION PLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL Cnrr\Lr FUEL rJ::tnLj(L I
FLUE SIZE RETURN OPENINGS INPUT ~ (" l::C) OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
~echanical
~Conditioning
O\~ OVent. System
.f1~Pl \Ce MAKE AND MODEB
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
~-..:( ~ -pA-r~NAC::0.-4
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39,50 minimum
$99,50 Residential, Additions & Alterations
$64,50 Residential, AC Only
$39,50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39,50
Estimated Cost $ Gf::::l::i:J ~
"
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3Q.CD
.50
t./D.LLJ
lice Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid -10-
Dat'll "24" .C,s-/
Receipt No. CZJ-ft1Z)
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372