HomeMy WebLinkAboutHeating Permit 07-0686 h
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CITY OF PR�OR �iKE Date Rec'd
� D� HEATING/AIR CONDITIONING/FIREPLACE PERMIT � 3 d, C� 7
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Please e or rint and si at bottom
ADDRESS n ZONING (oEfice
( �''i "�-� � ""�'�`'� ��'' I�U L"� e)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER / /
(Name) �Sj� !J, �.✓r� �+-. ,h! t°/� �� � (Phone) �p� � -y �Cp - � - 1��.j
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(Address)
APPLICANT
(Name�l. L�i�w.,t� - �,�r , � �,e�1('.� . � F, P (Phone) �Cv3 - S � - �Sas
(Address
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(Address) ( 'ty) (Zip Code)
(Contact Person) �� C'�S �e,rr�� (Phone) �� n� � S�I�D°�c� � �D
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT ,
❑Warm Air Plants ❑ Steam PLEASE NOTE:
�Gravity ❑ Hot Water Air Conditioner Units
❑ Mechanical ❑ Radiation Cannot Encroach ittto
❑Air Conditioning ❑ Special Devices Required Side Yard
❑Vent. System ❑ Other Devices Setbacks
FIREPLACE MAKE AND MODEL Jv
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1%of job cost Residential, Gas Fireplace 539.50
�39.50 minimum
Residential, Heating & A/C (New Construction) $99.50 Residential, Additions & Alterations 539.50
Residential, Heating Only (New Construction) �64.50 Residential, AC Only 539.50
Estimated Cost $ �atLP�� �v Building Permit #
HEATING PERMIT FEE $ �q, � �p
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ �-f p. O o
(Office Use Oniy)
This Application Becomes Your Building Permit When Approved Paid �� c ipt No.S ��
Dat � j �? y
Buildin8 Official Date l• J U d ,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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