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HomeMy WebLinkAboutPlumbing Permit 12-0140 E O O •n 000000 qg 0> z© ■ a . 0 At 8 8 z r k 6 o k m §�� § � 1,3 r �§ a k m § ©§Q P � etri k E is 2 § • 0 0 § q \ > 0 � c•s r o z k k 8 0 00000 z m m m g r ® � g r O M \ ' 2 �� ■ \ m p co _ r §kk k _ k 0 ti 2 n o z hif c -n r c§ 0 2 X 7 m n c 2 \ ❑o0O § B ) *k z 0 _ � Q ( -0 9 © m E § m % � 1 w� E )�§ 0 lc, PRip Date Rec'd �P CITY OF PRIOR LAKE PLUMBING PERMIT 3 2 1 2-- x jNNEsdc I. sole Applicant PERMIT NO /Z� /r 2. Gold City `� l'' 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) L O 'Lords N LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID WNER — 10 0— /D (N ame) © , d .fr-lbut ( Phone) (Address) L/4) ( 9 - $ � APPLICANT (Name) 31- 1815874 (Phone) (Address) Appliance Connections Inc tanita Circle (City) l ( ip Code) (Contact Person) 1 .. o • ee MN 55379 (Phone) r '1 eT 3 APPLICANT SIGNATURE i II L _ ' ' r / '_ ' / DATE orAid ,/ P ...... 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 The Minnesota Statutes § 326B.148 ost $ Building Permit # "SURCHARGE" has been extended I . until June 30, 2013, PLUMBING PERMIT FEE $ , The minimum surcharge for a STATE SURCHARGE $ 'i 11 I1 • "fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 'gra'fii This Application Becomes Your Building Permit When Approved Paid 571 5 Q Receipt No. Date "� z i By (9E/33 Buildin¢ Official Date J . 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372