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HomeMy WebLinkAboutPlumbing Permit 11-0537 0X0 0 00000 0 = O > 2 0 cn ii m n m 0 z 0 - -C c 0 0 0 z 00 z O 0 C =1zcn z m m p D o x x x 1 C m�c m � -n tli 4 m m �, / M N z D z 0 O >0 n D Z 0 0 -1 Z 0 -1 -i m t * n N 1 (n 0 z z O NI a O p , m r v -` S. m 73 O O 73 , , 0000❑❑ m m m m • 1 m �mDm� r • -1 c c vzi v v 1 x v 0 cn q 0 z 0 T w X� tp m O 0 i O -u W) 0 1 I� l '2E22 - x z 2 C m o -1 > 00o C 3 -1 m o O , 0 . ► r m 0 0 73 -1 F qb 0 NI -1 o Z ► 1 z cc z r O o P v _ • > v v 0 m - 0 1111 i' Ilk i 1 p 0 ir °< 1 )(❑0000 y m rr7T-nom `! 1 s , D )> cnmm3o m p rv t' z r v 0 4 Date Rec'd � x� �� CITY OF PRIOR LAKE PLUMBING PERMIT v � - -NEso Blue File Gold City PERMIT NO. // 537 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) i 6_1w 0 Ajc LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER , (Name) I t s- I'S r 1 (_-r (Phone) (Address) APPLICAN (Name) C` � - c r'r C. d 0 1 "rk 6I ' i ..�.r L (Phone) n5 q - 1 S Address 6 4 C) © I -i . % i e o :.-.r- � , 1 1 r o o r L, kL nAAJ S.S�1 (Address) Code) (dress) (City) (Zip (Contact Person) 0 °"^ (Phone) (0 1 X `-I e 3 "A D- y c l APPLICANT SIGNATURE DATE (o I D. 3)// APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins Dishwasher Water Heater Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink 1 Lawn Sprinkler 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 Estimated Cost $ Building Permit # The Minnesota Statutes § 326B.148 "SURCHARGE" has been changed for one PLUMBING PERMIT FEE $ year effective STATE SURCHARGE $ .50 July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit is 51, beginning July 1, 2010 This Application Becomes Y our Building Permit When Approved Paid 51,S 7) Rel No./ 3j 0 Date , silk,/ , - Building Official Date C� 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 i 4646 Dakota Street S.E., Prior Lake, Minnesota 55372