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HomeMy WebLinkAboutPlumbing Permit 12-0049 I Q D ) 0 000000 0 > z . n o■ 0 m zE� 0 o o 2 k A �c m $ m n© k� A MA'k m Z� >§§z z 0 73 • 0 �) Z U o 1 P z m A : ~ \t \ • 0 k , . § n� z mm • -n § \ in in 73 0 \ 11' 000000 un § m m rn r �§� � c \ z 0 m . m2xmmE m 0 0 • 0 >000 0 § .� k m 0 w >cc z m % R m r 11� 0 f K � § � � N g § ❑OOC X 1 1 8 0 ,mm \ z /fc ?, m 53- "n2 E m �� 0 V , C i P RIp Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT INNEs0 I. B lue File PERMIT NO . 4/ 2. Ye App i 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) ! s a n wil6,s NW LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER //--��,, ` 91(j r) I (Phone) , 3(.13., (Address) SCA,Ver..—Q....-- APPLICANT (Name) C.- lf" /oN PL 117 / 57A 1 (Phone) (Address) (Address) (City) (Zip Code) (Contact Person) (Phone) APPLICANT SIGNATURE DATE 1 — *--.1 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower : • Dishwasher Floor Drain • 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 M � 1 Residential, Additions & Alterations $49.50 lW The Minnesota Statutes § 326B.148 Est $ %]► Cd° Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ C' 0 is i5, beginning July 1, 2010 This Application Becomes Your Building Permit When Approved Paid 0 f '" j ) Re o. to t / 9 -7 Date/ By �7 7 Building Official Date I 1 Z 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 11/4Z1