HomeMy WebLinkAboutMechanical 04-1201
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
/2//.,,)4--
:ase type or print and sign at bottom)
" ~DRESS
/43L1q ~/{.J;)-M5Pd'~~. NC.
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/05
~~n ~!~, I PERMIT NO. ()4'-, IZ 0 I
Yellow Applicant .
/'
ZONING (office use)
)e/JO
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID ~ /I f 0 ') r. "G
&=e~R an.z:tt0 -bt.lf!&~
(Address) LI: W t~mJd-C'~ 1R. N--~
~~;~~AN~I ~/ ;1Yl~N#L/4
(Address) 1/~9 C:~ C/I(f Jf~
(Adi1ress) ,
(Contact Person) l?, (;//1 JiV~ / J-ey
,
(Phone)
(phone) ~?-~ -~
~/I7S1/l j iL ?67
(City) (Zip Code)
APPLICANT SIGNATURE'
(Phone)
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION PLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL ---/J/If::t-
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
REA TING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
ANDMODEL ~k~_kU~~
REQUEST FOR FINAL
Industrial, Commercial & Multi-Family INSPECTION SENT TO
SI ential, e' & NC (New Construction: OMEOWNER 10-06
Residentf,a!...JI\at1 g Only (New Construction) H
- ~,{~."
R l- j-\ <-t ~ c,., , Estimated Cost $ Building Permit # 0 '" JZ (I /
(Zl((, f) $ "'? a, .5--71
HEATING PERMIT FEE ~ v
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4D .00
OWarm Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
:place
$39,50
IS & Alterations
$39.50
$39.50
I
(Office Use Only)
~his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 40. d7J
Dat,)- ./. 11 +-
Receipt NO'4I"J 7 S-
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
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