HomeMy WebLinkAboutPlumbing Permit 11-0494 ❑ n 00000 0 _ 0 D NC?
' I O fnT - 11 1 1 11 0 0 -
0 0 0 g =I2 c0 m m m �
O D o 77 7J xi C m � c 3z-� y �T
O 0 N Z v - c) > O O N z xi
tn -a --I m O O Z O
D C) Z z
O
cn
tz o \`� z z S m
• 11 D O 1 1- O Z '
'1 ii
= m 11 11
4' m °3 0 0 '�I 0000❑❑ ►
m m
X m m 1 3 * 3 13 -1
O
c c
m m m D m
* -I N o o z 3 m z 3 11 0 — N a
., z O 11 T =M W m 0 0
i O -0 7 0 z S S z z m
Y C m m -4 DO00 O 3 -1
�+
0 r TOO x -1 r: C 0
b -4 o Z Z C C 2 r
z Co x O '� v
O N
• A 0 ' NV
• 0
m
c
°< )00 000 -L
Z Z z D 2 T, O -4) m
• > y m m 3 0
a > O Z t 0 D m c
0 > mm Z in
:. 71 N Z z m
(,... RI Date Rec'd
4 CITY OF PRIOR LAKE PLUMBING PERMIT 6././/
41IA'NESdcP 1. Blue File
2. Gold City PERMIT NO. / /L.
3 Yellow Applicant 7
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/6o77 n (A Z 2L
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � �
(Name) - J (Phone)
(Address) / 6 O 7 7 Ito f "l , oo c- (2. a ..
APPLICANT
(Name) � C Uc-t4 1" 1 ()Ai b I "t� (Phone) 6 /? - Z 70 - 6 1'7Z -
(Address) e' 0 . (Z S 1 i o( t o C (fat tr . IS
J 3 7z.
(Address) (City) (Zip Code)
(Contact Person) (Phone) APPLICANT SIGNATURE , DATE /t//,.r
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher X 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 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
r ,. ` :. -- - ` ' "ist $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ .50
July 1, surc until June "fixed 2011. `--
The minimum surcharge for a "fixed feee" permit TOTAL PERMIT FEE $ ✓` r
is $5, beginning July 1, 2010
1'his Application Becomes Your Building Permit When Approved Paid _5/f3 Ree l o. 63/0i
Building Official Date Date /6 ii By '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 /
4646 Dakota Street S.E., Prior Lake, Minnesota 55372