HomeMy WebLinkAboutMechanical Permit 10. 0658 PR/0 CITY OF PRIOR LAKE Rec'd
�� HEATING /AIR CONDITIO NG/F P E P T
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4*NNEsoo 1. Pin F PERMIT NO .
2. Green C ity /p 6 sg
3. Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
qq q�' /6 614 , 'F
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER t �p
(Name) .//,., / I'M , 1 T 1 fl V L e (Phone) Q :Z " 1/4 7 /
(Address) /s? ' ? 64y ZIn h Q !f" 4 / v /7) L
APPLICAIT
(Name) A c • o n Y€ a7 % ' 1 7 (Phone) 6 /2 -36' -3 7' 9
(Address) 3 55"2 �`Qr,A ;Ap 5 t 514/ /3 too. A eke- SIS3 7e.
(Address) V (City) (Zip Code)
(Contact Person) / (Phone) (Ol 2. -3 64, - 31/34
Contact Person / 6
APPLICANT SIGNATURE _!r� • � c � _ DATE
/
APPLICANT PLEASE COMPLETE BELOW •
❑NEW CONSTRUCTION ❑ REPLACEMENT X 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.
IA Mechanical ❑ Radiation
.ir Conditioning ❑ Special Devices Fireplaces with Box Additions or
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Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
� pal-. �� Require a Building Permit.
FIREPLACE MAKE AND MODEL a�`
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 $ 1) 252) Building Permit #
HEATING PERMIT FEE $ S7, SO
STATE SURCHARGE $ 5. 190
TOTAL PERMIT FEE $ 1 '5°
(Office Use Only)
This App • • t' n; comes Your Building Per it W en Approved Paid 92` Rec ' t No. 1 ���
! /� 8 .S / O Date U B
uildine • Mc utl ate L `
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372