HomeMy WebLinkAboutPlumbing Permit 10-1132 N � �� (� ❑O❑❑❑❑ 'c O D Zc�
O N�,-�n�+�+ �'
v
n ° o o p � - � z c = n�co m m m �O
t� � � �� v�, 3 N � � y 0 �
9e � n > Z � o�=�� Z O
ro� ��-, N� z Z o�
�° o � z-��i z C � m�
� � � n D � �
� r Z �
� � � �
a. _
� m z o o ODOO❑❑ �
'� m m m m m � � .
� � a, ° ° i3�mi3
� � Z � � ������ m o A
C �'m n Z G�ip = o � 3 � m
�o m a =� � r � � � o
� O � � D�� O m
O Z ;, � r' O
� A O �
= m �
� c � � �
� � rn �OOO�❑ ` 7u
� �f �n A(n �►
� = Z D���Z� � m
ymm3�
� � � ����
� D m mm �
z z��
� m ��� r ;
�
-� � � m
� pRip Date Rec'd
� �� CITY OF PRIOR LAKE PLUMBING PERMIT
� �
�
1. Blue File pERMIT NO . � Q l/�
2. Gold City
3. Yellow Applicant �
Please or 'nt and si at bottom
ADDRESS ZONING (office u�e)
8�.5 ���1�ow �„�o�c� ..� S537a
LEGAL DESCR�TION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER � (� n
(Name) Da�f1 �-' 1"� Vl O�r�.c� �� 2� � _ (Phone) �o� a �S ( 7-� 4�O a
(Address) 3� ZS �� � �.1�,J00� �
APPLICANT
(Name) CULLIG,��V WoTFR r (Phone)
6030 CULLIGAN WAY
(Address) �n �,n �n n��c n � � �� � ��-
����933-7200 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE DATE I ' c�y' - I �
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fizture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 st $�(�� .�u Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ �{9 .SO
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ S. Ov .�$
The minimum surcharge for a"fixed fee" permit TOTAL PERMIT FEE $ 5 y, S l�
is �5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid �, ` ec ipt No.� ��� v
�'
Date � � �� y
Buildine Ofticial Date
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372