HomeMy WebLinkAboutPlumbing Permit 12-0092 y ❑❑ 0 0000❑❑ z 0 D v N
v 0 cn n m m m O o -
c> n n o n o o 0 3 -izco 00 m m m m0
msc
1'21 r m n D m u z , r SzD Z p p �
� IV \ - m o �=io ZO
to o N c N om z 0; ui a7 ,
o co m
�• z o z �/ m m
m n
0 r z F, 1 111
r o
= m T/ 'V
z ;v 0 0 0000❑❑ l
� m m
m m m 3 �y53m
p x3 mx3 -o 0 cn
y m F m \ .nc°71 �m, m O 0
m m -� >OxO0 0 3 - m
C7 n 0 c� y r-nOO x =i* F 0
'i o z z 7C 7C z r c
`c—"' > o 0 m
O
A 0
= m xi
c 0 N ■
m ❑❑❑❑❑ 1
y
R. D 0 Nmm3 (\) < ^ rvmv - 0
J m
4 ' D ►m���>
"el z D At� Z .n
n mm -I _
m ,m om c s
A i Z z m
-1
1 r G1
V Date Rec'd
C). RIO
CITY OF PRIOR LAKE PLUMBING PERMIT 2
._
omit
�I�'NESD�
'. Gold City PERMIT NO. iz 2. Gold City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5770 (kr4 gide J ir 1 5
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID L/11(2—
(Name) ZCt h V)P, 1 rlLf) l c (Phone) W
(Address) anv. RI l.J r N 55372_
(Nam AN � /�_ f �` b- Pl1 , ( Ph on e) 1 �`Ac V
(Nam w1 I 1 — S�O
(Address) _4_, l O R ,“ �5 I 2_,3 ` l� `� 1 (Address) ( i ( ` (Zip Code
(Contact Person ' S (Phone) — 3 1 3- l O
APPLICANT SIGNATURE ` �� . �rl��..�rv-- DATE 7 2 -
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher J 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
Fctimateel Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ r rl q• SO
until June 30, 2013, STATE SURCHARGE $ 5E 0.6
The minimum surcharge for a TOTAL PERMIT FEE $ , 5
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid S — _. Re' Ngr C1 �7� t'/
Date B
Buildine Official Date L- - 7- /2_
`
( � 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372