HomeMy WebLinkAboutMechanical Permit 11. 0554 2
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of P Ri p � CITY OF PRIOR LAKE Date Rec'd
� HEATING /AIR CONDITIONING /FIREPLACE PERMIT
1 '
41'NNESDt. 1. T NO.
2. GreenPink File PERMIT 1 1� //- 55//_
3. Yellow Applicant ` "T
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
61 /Pi
5 E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �` i KteINad ( � L 'e � t (Phone) f
(Address) 6(c3 / E� 1 44-fre,i4 / A1 ..")Q g
APPLICAN 3'`'���� � r� ,��/
(Name) (. 1.`� "/ (. - / C.� i (Phone) 95:
(Address) ?472 /�l i-- U ��f fte / u=° �' u' ?- ✓ /
( dress) (City) / y t (Zip Code)
�/'�� 5" / /
(Contact Person) � Al :,► e — (Phone) 9. f ( �15
f
APPLICANT SIGNATURE i !i - ~ DATE __Of/1(
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION KREPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL Car t/4 tL/Q FUEL 1V-6
/� t
FLUE SIZE CA l/ fIs(% RETURN OPENINGS INPUT 44,46rn OUTPUT 76 * _ D
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
1v4 arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
• Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
u Conditioning ❑Special Devices Fireplaces with Box Additions or
]V System ❑Other Devices Cantilevers to the Outside of Buildings
��� _, _, /44104 R�; ire a Building Permit.
MAKE AND MODEL ' L � ' ; �arf � V '
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
1 uc IVIIIIIICSULC )LatuLCS 9 .)LOO.> 4a ■st $ Building Permit #
"SURCHARGE" has been changed for one
year effective
July 1, 2010, until June 30, 2011. EATING PERMIT FEE $ 't S7)
The minimum surcharge for a "fixed fee" permit TATE SURCHARGE $ ..� _ — • .1P
is, beginning July 1, 2010 OTAL PERMIT FEE , � •fir 4
This Application Becomes Your Building Permit When Approved Paid -i Re • t No. 63/03
Date -
Building Official Date (O ' ` //
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372