HomeMy WebLinkAboutPlumbing Permit (dishwasher) 11-1195 - o o' o o 0000 - 0 o > E
§ 0 0 \� )k§kk§ m §\
R m■ m m Zr E V E 0 $ -
tri � \ §\
m ) � §§ 0 z-
2 t ■ @ q 2 § ■
§ \ � \ • 0 B / E
-^ .0 z w m m
j 0 - o _ .
-4 - 0 - 0 (
2 00 ^0 _ 000000 \�
gmm \ ƒ m -a * ; -0
2 Ko o p nc _1§
%� cn
) 2 m %§ m 0 0
g 2 0 f 0 3.000 0 3 q m
Nn - o z r 2kk
k Z K m r � � m
I k » � _
^ �� c . g -
§ D00000 \
Q2 -onq � . )
R. T. § \ )k ®
\ z zkk ;§ \ �
§ x m 7 ® r <7) — 73 -I z r ■
-4 r- z ..
A)
)).
Date Rec'd
4 ., RL�� CITY OF PRIOR LAKE PLUMBING PERMIT
4,„„NEscr„
I. Blue File
z. gala city 7.5--
PERMIT NO ` / . / /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
� ZONING (office use)
15 �ti)y__ ∎ aL SC
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Tt i >tn D .s 1 /1- ` `� �- > (a c \ (Phone)
(Address)
APPLICANT
(Name) C. r - .C.,■[ ,x -rr—, e N. c. (Phone) ^? Le3 -- 1 $3— 961-1 q
(Address) J L{ i. \ 9. ay-, a (An I ,c��a.� -��, LE `-t
(Address) (City) (Zip Code)
(Contact Person) '•E _ a. (Phone) — ltro .---- Y63 -2 I S
APPLICANT SIGNATURE ,7 �! • DATE ih - 0- 1(
t
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 Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes ¢ 32613.148 .. ist $ 56d Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ q C I So
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ G. 06 :Ea
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ `jt'{ • -.3p
is u, beginning duly. 1, 2010 '
Thi S i plica ' . n B / o i / our Building Permit When Approved Paid S7 ,-O Ifipt (Q No. j 6
1 i d / /(•. ¢ // Dat / 7 Q . ` �j
r Building •ffici, Date f�r • `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 ,
4646 Dakota Street S.E., Prior Lake, Minnesota 55372