HomeMy WebLinkAboutBuilding Permit 12. 0948 J
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PRip CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
INNESd
2. 1 Pi Green File City hz PERMIT NO. _ b / �� q///pIIY
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/55 V/ /4//idiVO 4 vE . 4/t/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER C
(Name) ,) trLLy ri/2 (Phone) 25 6
(Address) /5 V/ ///6/1Z r¢/tJ? X9 1/ £ A/ 1,t
APPLICANT
(Name) .r Cl,h•✓Aitij"C S 1f,4-7/ N6- (Phone) t!o 5/- I/57-333 /
(Address) 44 /5' O I E At/ A 1/‘. . A/ 3T L L 1,./ 4 rf' .554 Yc
��
(Address) (City) (Zip Code)
(Contact Person) �.J - 7 E t (Phone) 6 q' 333
APPLICANT SIGNATURE DATE r-/‘-/.
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ✓❑REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
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 Box Additions or
['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
The Minnesota Statutes § 326B.148 r2ost $ Building Permit #
"SURCHARGE has been extended
until June 30, 2013, HEATING PERMIT FEE $ i/ 9-
The minimum surcharge for a STATE SURCHARGE $ - T J OO
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ .J -. V
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid s4 Receipt No. j / qbc
Date y By
Buildine Official Date Vi oh2-- 7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372