Loading...
HomeMy WebLinkAboutPlumbing Permit 11-0854 O�O n 000000 0 > En PO r) n k 0 00 0 Of 11 z m z � � � m o k § m m § -oil 4111> m §� § §2k z § §� % : • q $1 -I m 0 k to > m 2 g z z 0■ e �� / 0 o 2 N) o x j 0 2 • m ® § 7 \ % z 20 0 000000 fit § -.m m Ad■ - m 13 ® $m 13 2 w 4" o NI o f -IoZ k z i - ii �� } § ■ q$§ m 0 o § \ \ a \ > 0 _ 2 z P m \ $ I k k c § $ § CO r § § § / k o = m (lb T 0 q § x E000 , m =2n ; Rs v cn mm 0 V » \ 0 \\ n mm q m / ] z - K w1- o V C iN R0 CITY OF PRIOR LAKE PLUMBING PERMIT 'd 30 Date Rec NESD ,0 I. Blue File 2 Gold City PERMIT NO. / /' , 6 . 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (orrice use) V260 Qvabr - , 1 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER EV r -Aim �� (Name) A7,74y (Phone) (Address) ( N ame ) N� / �ZI/ �`d / % 4 I 'Lc Phone) SO 7 " 6 /J - 765 (Name) ��� l �/ .� (Address) 1/ 7 /t ✓t' 9� �� /a / " ,%'-s (Address) CAP (City) �� (Zip Code) _— a1v^ 2 VF r 7P 7Z_ (Contact Person) ff APPLICANT SIGNATURE _ _.r DATE ." ©`/ 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 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50 Residential, Additions & Alterations $49.50 ' ' ' ost $ Building Permit # The Minnesota Statutes § 326B.148 "SURCHARGE" has been extended PLUMBING PERMIT FEE $ until June 30, 2013, STATE SURCHARGE $ .50 The minimum surcharge for a TOTAL PERMIT FEE $ "fixed fee" permit is $5.00 This Application Becomes Your Building Permit When Approved Pai 3 v Receipt . 6 9 3%, � / By ( Buildine Official Date DateV 3o ` 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372