HomeMy WebLinkAboutHEATING 07-0154
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CITY OF PRIOR LAKE I ~~~e Rec'd
~~~~I~z.'NDITIONINGIFIREPLACE ~RWr 2 2 Z007 "'.1
'l[ Il{ ,,~ i ~~~;. :~~"lli' 1~RMIT'"NO'07 ~ 6 1S4i
\t'lease type or print and si~n at bottom)
ADDRESS If) 1. ~
/1/S/i- rrlfKL5fUli ./Jztduu){ tlf/~' SidJ
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID/S" ,'541. 6/r-.O
,
&':.:R DOYlCLI1 ,TtA $ 5 ---/
(Address) tjlS-a IJua~t ~ui/)N) ..~ SuJ
"J,:;~~~li0f~, ,I ilw.d:y ~ ()'hone) 9Q~ '19 d- 9.;J 7,0
(Address)jJ)O ~ by- "-)tJ1~ 6:J'--3S-d
~ (li-dtes.S). "VI' (City) (Zip Code)
(Contact Person) -:]:/YJ JilL'nuk' (Phone) qS;)- '-f-ti:J- -9;; 7{,
(Phone)
7S-;)Af<f7- (:;3&9
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
[]NEW CONSTRUCTION D REPLACEMENT ~ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
TYPE OF SYSTEM
RETURN OPENINGS
INPUT
OUTPUT
PLEASE NOTE: Air Conditioner
DWarm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
DGravity 0 Hot Water into Required Side Yard Setbacks.
o Mechanical 0 Radiation
DAir Conditioning 0 Special Devices Fireplaces with Box Additions or
OVen!. System 0 Other Devices Cantilevers to the Outside of Buildings
, V \ Ii Require a Building Permit.
. FIREPLACE MAKE AND MODELMLi lItatTwo ~b{;r5. "'151~~ .,
,/ I i '1-. ~~rl.t{...,
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
HEATING OR POWER PLANT
Industrial, Commercial & Multi-Family
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
", .. rJrJ
. ?'\otxJ./
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
:J. 1 j'U
.50
4-t-1 A,.--(
(Office Use Only)
'his Application Becomes Your Building Permit When Approved
Buildine Official
Date
Pai<!fo. (/D
Date..:.? 2.... 2. , 07
Recf~o. 632--11
BI( .
fJ
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372