HomeMy WebLinkAboutMechanical Permit 12. 0473 •
W Z _ - _ F �
i J CC W ix % V k
CD
8 555= z
(Ne la c j 0 2 W LU ja 18 0 CI ‘u
❑0000❑
1 c J 0 o
N
O N
W Z O
w O »< . W c 0 W
" a2 Q8 8 8 u. J z N W ka
O 0
SS
f W X 0 .1 V c
X O w apa Ce rt mti : :: N Z
N 0 a S W Z
W J W ac
a 4C 3waTe • I , W U ce z u'
1 0000❑❑ • W
. "' ` O as LL I
S p J
o a < 0 u. IQ
z
W W z C1 O - ie o4
V `' 0 < F- co
5 0 -
z u It � c a
0 Z O = W F_ % < F F- I oC
Z ■ 1 N V V J Ly
�5 O < 4 Z ZO N W Y Ce Ce L J A tso
Oa OC W z OOOCNZI- M O O yy
N 0 O LLLLLL O 3 0 0 N
0Z < 0 a 0 000❑❑ 0 r • •
I jR/ 0 � CITY OF PRIOR LAKE Date Rec'd
. HEATING /AIR CONDITIONING/FIREPLACE PERMIT 5 Z3 / Z
,,,„,,i ,74, .,,
.NEsoo 1. Pink File
2. Green city PERMIT NO. ' 2, 4,-7
3. Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) t 1 di( - (Phone)
(Address)
APPLICANT
9 62$5? (Name) t 4 IG 'C L�O , '� ��hone)
(Address) / .[t% 014 (V`'C-- 41.44- (4' #I ,/'........------
(Address) (City) (Zip Code)
(Contact Person) 1-77r\ , ,
(Phone ) ' ;' Z 36 /A
//
APPLICANT SIGNATURE ��J 1 a DATE — Z --
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
['Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
❑Gravity ❑Hot Water Units and Fireplaces Cannot Encroach
❑ apical into Required Side Yard Setbacks.
❑ Radiation
i Conditioning ❑ Special Devices Fireplaces with Box Additions or
p
Vent. System
0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE D 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
.,.`:_ - -- ' Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended
until June 3 0, 2013, HEATING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid .i '1,t No.67 j�
Q
Date III!
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372