HomeMy WebLinkAboutMechanical Permit #12-1346 � ❑ ❑ C� ❑��OO❑ � � o Z�?
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� pRi� CITY OF PRIOR LAKE Date Rec'd
� �� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� � 11-�-�y
� ' p "� F;, PERMIT NO. �
� z. cree� ary _ iA
3. Yellow Applicant ��
Please e or ' t and si at bottom
ADDRESS ZONING (oflf Use)
� ��� G'✓/ LLO � i�i1d�G ,$�%'�T �, ��
LEGAL DESCRIPTION (oi�ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � (�/ /l��/�L7'7� S�4 V/C�s (Phone) 6 /� — fi'7.� '��a-9'8
(Address) L/40 S77tiJ'oti LYD� /��� MP�l' M^'' S�y/-3.
APPLICANT
(Name) GD�t� /�fEG.HA N/ C.¢-L (Phone) � -r�..�'- �� ��
(Address) �/ /�f /�/�-f BD.�o >9- tl.E'� MO� , ,�� IiR4 /�dl � /�J/l/ .�$�y��
(Address) (City) (Zip Code)
(Contact Person) � � o �� (Phone) . �76 3 — �1 /� 38 �'
APPLICANT SIGNATURE � DATE �� � "
APPLICANT PLEASE COMPLETE BELOW
JtoaFJv� !/N �T ❑NEW CONSTRUCTION ,�REPLACEMENT ❑ ALTERATIONS
� MAKE AND MODEL � �/8NG'�EA6 y/¢�,q,s' 3�� FUEL N�'`� GvtS �L��
�—
FLUE SIZE �¢ RETURN OPENINGS PL.���/M iNPUT r J % 41�p OUTPUT S�, �O
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
,�//LE�T /2�p�„�G��y�ivT Require a Building Permit.
,�c isT�� G 3 —7?� Gj�F�
/
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 Constntction) $64.50 Residential, AC Only $49.50
Estimated Cost $ ' �.�0. (J� Building Permit # — ��
HEATING PERMIT FEE $ 6'7 -3 0
STATE SURCHARGE $ S. Q$D
TOTAL PERMIT FEE $ �' a 2 .� O
�ot�ce use oo�y>
This plication Becomes Your Building Permit When Approved Pai¢ j_�� Rec�ipt No.
� (� hC��- 40
f ( '— � �� Date By ' / n
Buildin¢ Ofticial Date � �' 7 ^�°� 'C7�
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372