HomeMy WebLinkAboutHeating 06-1039
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CITY O:F PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink
2. Green
3. Yellow
~:~y \ PERMIT NO. tJ0-/t>3\4
Applicant I
ZONING (office use)
ADDRESS
/.y:lf'!
LEGAL DESCRIPTION (office use only)
PID
r
LOT t5' BLOCK
ADDITION
OWNER
(Name)
(Phone)
(Address)
APPLICANT
(Name) tJf N{'h1(j'NN
(Address) ~f; 1'~2.V-
/J'/n fJ
IJr
(Address)
(Phone)
f'tPt?11/1/
-l (City)
55 I ,;2 ~
(Zip Code)
A.PPLICANT SIGNATURE
(Phone) .(; I .2 - J ~ f' 7~ / :L-
DATE - - () t,
(Contact Person)
ONEW CONSTRUCTION o REPLACEMENT o AL TERA nONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
OWarm Air Plants o Steam Units and Fireplaces Cannot Encroach
OGravity o Hot Water into Required Side Yard Setbacks.
o Mechanical o Radiation
OAir Conditioning o Special Devices Fireplaces with Box Additions or
OVent. System o Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
T PLEASE COMPLETE BELOW
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
3q ':)-0
LI .50
o . .....--
This Application Becomes Your Building Permit When Approved
lice Use Only)
Buildin\! Official
Date
Paid {1-
Datell_11~b
Receipt NO'5J 5~
B
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372