HomeMy WebLinkAboutHEATING 07-0049
Date Rec'd
CITY OF PRIOR LAKE
HEATING/MR cro~DITIONING/FIREPLACE PERMIT
CLloSA-~'." ~
11l('a~
(Please type or vrint and si~n at bottom)
ADDRESS
l51f'J \ \0est ,"\J~
\ ().rII)(LallL
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
I. Pink
2. Grecn
3. Yellow
~~~y \ PERMIT NO. (;""-'1 (;/',A /J
Applicant I (~ . ~f
I
ZONING (office use)
PID
(Phone) 25;) - 4!JJ~3&r3
553/:)-
&'::~R ChClrt €-~ S l'ln&o,(
(Address) l5"l'l \ L ){7..<:\--!\V ~ \ r (\ f){ LeA tt I VV\ tJ
APPLICANT/, \ 1\ \ 1_ , \ D
(Name) {:o O\.'\i~ \~Qr+'Y\.-\- lIo(Y)<2 (Phone) ~/'S::l~Lf-Cld.-q),7 ""
(Address)JOO 8&(Yt:lClO Dr I - _\()yclQh) Yv\l\] 5_S3S,"":)
(Address) (City) (Zip Code)
(ContactPmon) TrY\ /Sh\Y'l\~~ (Phone)J/SiH-t!D- 7:J:,(o
APPLICANT SIGNATURE /~ d~~ :pATE ~ 0')
/ ~ _ /~ . i
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT [g'ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
~n-\- ~ (:} \ n
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
FIREPLACE MAKE AND MODEL
;S L- t:tiJ\\2S-l ~\::1L
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
~o~
$39.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ , S'" 00 cO
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$ ,set.SO
$ .50
$ 4l),OQ
~ ~
(Office Use Only)
'his Application Becomes Your Building Permit When Approved
Paid 40.00
Date, Z {~ ('\ 1
I _ '.,.-T'"J ...... I
I
ReceiPt No, h. Zl'.l1JL:::2.
.I ,.I L~J
By'
I
Buildinl! Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 );
16200 Eagle Creek Avenue, Prior Lake, MN 55372