HomeMy WebLinkAboutHeating & A/C Permit #12-017 � ❑ ❑ _ C� 000�0❑ = O o Z�
n �� o 0 0 3��y��p z�� m0
� m m
� � m m y R y p � N p'9
n Z . ��� Z �
p � n y N � Z Z � ��
C m � 'r
� � � _ � Z � m �
o m
� � r Z � � �
r o
� � � �
s
� m � o o ❑❑❑❑❑❑
m m m m 3vtn�;v
� ..�.� N v o � �c ��c
� � z g � `� ,_,��� � m O � c�'i
C �° � � y� 3 - m
b n n p rT�� ��� C
� p� Z D � � Z -I— m
o z� � N_ ��� � v
� A �
� � � t �
�, y < �' ❑❑a❑a❑ �
y = � c�„��� >
� D � ymm3G� � m
� D � m����
� n >mmZ�1
� m �°,���� 1
� .� � - r m
'� r �
o � p R jo �� CITY OF PRIOR LAKE Date Rec'd
/AIR CONDITIONING/FIREPLACE PERMIT
� :� �uM�31��
�
�j � . . .. � �,Q' 1. Pink File
j NNES� 2. Gceen City PERMIT NO . ` �
3. Yellow Applicant /� �/
lease e or rint and si at bottom
ADDRESS ZONING (ofl['ice nse)
�(O d- ��� �
LEGAL DESCRIl�TION (ofl['ice use only)
LOT BLOCK ADDITION PID
(Na 11 i , K. �G r !'e I � (Phone) � �d — � �� � 3 y3
(Address) j c� � � � DY� � �
(NameC� I1 ! C. l� � f t� � 1 (Phone) � / � �
(Address) � �'/'�I
(Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE f DATE �
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS OUTPUT
TYPE OF SYSTEM HEATING OR P R PLANT
EASE NOTE: Air Conditioner
❑Warm Air Plants ❑ 5�� `�v �� its and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water V� i to Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Dev� � � 'Fireplaces with Box Additions or
OVent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
The Minnesota Statutes § 326B.148 Cost $ Building Permit #
"SURCHARGE" has been extended
until june 30, 2013, HEATING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ ,��..�
This Application Becomes Your Building Permit When Approved Paid �� r-�l Receipt No. b
..J (J
Date �/, I � By '
Buildine OfTcial Date
24 hour norice for atl inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street 5.E., Prior Lake, Minnesota 553�2