HomeMy WebLinkAboutMechanical Permit 14. 0872 J
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04 p R10� CITY OF PRIOR LAKE Date Rec'd
a, e HEATING/AIR CONDITIONING/FIREPLACE PERMIT �J
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4iNNESOc� .Preen File PERMIT NO �y�
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3.Yellow Applicant �1/
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/ .S'(a E3 /iv 11. n/ id_ pa) fr ®K 1-,Sc jfk}s 3 3
LEGAL DESCRIPTION(office use only) •
LOT' BLOCK / ADDITION .--'z 1. 4-,ci J 14€1.4) ✓�I I PID p75:- /�-,6/ 4)
OWNER
(Name) 1. . I i (Phone) 9s-, .- a‘_.Zh
(Address) `T r - _ __ � !-`e- // . o k �L`
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APPLICAN
(Name) _ a !' ii // i (Phone) '9<c?'--5?
Tfr
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(Address) `d i - , _ C A Cl DAfr-l—kir ✓
(Address) I (City) (Zip Code)
(Contact Person) _- c.- ' - (Phone) c '--- 9X72 S�'
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APPLICANT SIGNATURE ,d ... DATE _ee_/_ZsV/ ____
I _D_
APPLICANT PLEME COMPLETE BELOW
❑NEW CONS RUCTION NREPLACEMENT 0 ALTERATIONS ,
FURNACE MAKE AND MODEL C_0 i'rhe' r7'3r/ ® is/017 FUEL 1,1
FLUE SIZE RETURN OPENINGS INPUT 0000 OUTPUT /a Co00
TYPE OF SYSTEM HEATING OR POWER PLANT
' arm Air PlantsPLEASE NOTE: Air Conditioner
0 Steam Units and Fireplaces Cannot Encroach
■Gravity 0 Hot Water
0 Mechanical into Required Side Yard Setbacks.
❑Radiation
it Conditioning El Special Devices Fireplaces with Box Additions or
■Vent.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&AJC(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended ost$ Building Permit #
until June 30,2013, qq
The minimum surcharge for a HEATING PERMIT FEE $ 171-50
"fixed fee"permit is$5.00 STATE SURCHARGE $ stitQ'
fOTAL PERMIT FEE $ •S 'Z -SO'
(Office Use Only)
This Application Becomes Your Building Permit When Approved aQ
Receipt No.. 5jJ,�� �011ate By
Building Official Date 6, �� , I 6
+ 7
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372