HomeMy WebLinkAboutHeating Permit 13. 79 J
w Z _ Y 0
'� oLLI Z 4.
u, 0 _ ` _ W OU m Li U' z .._
i...,.
O T. 000000 - w co
0 O
W =
N
O II , I. • W L Z O
W O » a a E O w
n �4 z YYZ % Z 0 U 4,
!_ ' O O J
D i U< F- W o C r,
i z a z L 1 0 c � a. o
mm. re re mLL' ') a 0 ,4 3
u) a Dwd =0l I I w 0 °w z X o
d W W W W � co
re
❑❑ ❑❑❑❑ o o Z ° e
3 a a I
re
0 `= U LLO
E O 0 a O : co
O Z F" 0 U � ..� a
W F- f' W
—z c� a� o ( 7, 2 ai .► 4 w
a � 0 Z zo?g z W Y a J A
LL W W W Do < qt v O i i ► W - O
ce � O � O U
L 0 O OOW ZU. rn 0 3 0 0 a
UZ Q 0 a 0 000❑❑ 0 ❑ 0 c
JoE 1L1$ �
Ip CITY OF PRIOR LAKE ate Rec'd
o P R I � HEATING /AIR CONDITIONING /FIREPLACE PERMIT <, 5q_50
N - S . 1. P File
INNEs 2. Green ink City PERMIT NO. /3 _ O N
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
305 L 9d C Na (-+
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNS ' ,� C Le I Z 1 2 1 0
(Name) � �M' 1 J CM a el � (Phone) c` D � l�
(Address) 3 052. W I [ C1 5 2-1 Ace_ ('F
APPLICANT j4 `r r
(Name) Q IC on VI ors t_ � ∎ ,/ rit ■ 'IA •� " (phone) LiS 4-2 7 - f t 1 , I
(Address)! l 0 Li V-0 (0.1 / 1 i t 0 S' /4/ � ? � U S /" 4- 5 C i
(Address) L ( ty) (Zip Code)
(Contact Person) � (Phone) ! t_ ` L i- f
APPLICANT SIGNATURE / . . i i ✓�y.i DATE / t _
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION / REPLACEMENT ❑ ALTERATIONS
Y
FURNACE MAKE AND MODEL t JC. CO s-}' C7 � L. "! � c o FUEL Nai ( as
FLUE SIZE RETURN OPENINGS INPUT kip OUTPUT - 1 ( 0
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 0 Radiation Fireplaces with Box Additions or
. ' it Conditioning ❑ Special Devices
❑Vent. 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
Estimated Cost $ Building Perrnit #
HEATING PERMIT FEE $ ` , SS
STATE SURCHARGE $ S 04
TOTAL PERMIT FEE $ - D
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid t -' ` co Receipt No.k j3-6
-
Date J //2.-' //3 By
Buildine Official Date �t -r•C_/
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372