HomeMy WebLinkAboutMechanical Permit 13. 1002 J
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4 1 R I CITY OF PRIOR LAKE Date Rec'd
° { HEATING /AIR CONDITIONING/FIREPLACE PERMIT
>�: 5- , fig
ifl SO I. Pink F;I� PERMIT NO.
_ 3 . Y e U City / - / /�
� 3. Yellow Applicant l0
(Please type or print and sign at bottom)
ADDRESS ZONING (office use
■
-3 `lO7 G/ood DL.c . /2dQ A/k/ •
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N R -,1 H`d'''!!.°S `. iniierj O EL 1/..ik/ (Phone) ?.�02"- y 9 / 9O.3 •
(Address) 3! O g t /7 pei.,k /3 A/A/ / 2f L AkG , v 5 :5 5 Z,�
APPLIC ry� p ' J r � /
(Name) Oee,)1 2 - l'r7 f'� f .Ct�7 /,9 (Phone) 6/2 /2 — 96,5 o -.e
(Address) 2 &5- �-> -,0�. , Z,/s.Pe ' //G f� . T 79 /
( (A Address) (City) / (Zip Code)
(Contact Person) .SG ? %LGC --i f /V (Phone) e 7 , 2 — ?.a- .5--e- - R l -?
APPLICANT SIGNATURE .., ►' ■_ t" DATE 9 —. /3
APPLICANT PLEASE COMPLETE BELOW •
•
ANEW CONSTRUCTION REPLACEMENT D ALTERATIONS •
,Nr-
FURNACE MAKE AND MODEL Z 'TF 'I /O FUEL , e� 69-J
FLUE SIZE 3'� RETURN OPENINGS .3 �� INPUT / U4 0c90 OUTPUT ?WO
TYPE OF SYSTEM HEATING OR POWER PLANT .
�]Watm Air Plants Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
DGravity ,Hot Water
D Mechanical ❑Radiation into Required Side Yard Setbacks.
DAir Conditioning 0 Special Devices Fireplaces with Box Additions or
DVent. System 0 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 Permit #
The Minnesota Statutes § 326B.148
HEATING PERMIT FEB $ "S(. RCI IARCiE" has been changed for one
year effective
STATE SURCHARGE $ .50 duly 1, 2010. until June 30, 2011.
TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit
(Office Use Only) is ti,,, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid 5 3 Rece' o. iG C 7 41_,.
Date i3 By
Building Official Date 7., ' ' ' `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372