HomeMy WebLinkAboutPlumbing Permit #10-0840 � ❑ �� C� ❑DO❑O❑ � O D Zc�
� O v,„-�,„„ o � ° o �'�
n c� 2 °°� 3 m>c�co m'" m no
0 y o ��� 3 r 3z� Z � tn T
�
� m �� Z� S�, o `� Z o
-+ ' .� m
�i ° o z �
ro , � u, V� � Z z o�
� � 7� � � z n 7�
° z -� m m
� � � o �
r
� � � v 'v
Z � n � OOO�I]O
'� x m m m , m�
� "� c ° ° =�rt�mx� � cn
Z � �o 00 � w
° c � � � � ��oo c � Z m
� �°' n � � r�00 70 � � C
n
� z � m ��� � o
� A �
= m Q.
� c
y < �7❑O�O �
� Z z >���Z r�
� > � cn� �
�
� a = ��50
� � m � ���'�� �
, i � — r _ m
�r �
� p RI Date Rec'd
° �� CITY OF PRIOR LAKE PLUMBING PERMIT
� x
� �
�
1. Blue File pERMIT NO � � . ��/�
2. Gold City
3. Yellow Applicant V
lease e or rint and si at bottom
ADDRESS ZONING �ot�«,�>
2.�( '��n l�,e, f�d- Sv�/
LEGAL DESCRIPTION (ofl'ice use only)
LOT BLOCK ADDITION PID
o�R . q5a -� �r 3� �a z:�
(Name) � (Phone) _�
` 5
(Address) �,.(JV�� • �
� PLIj ANT ° � ��1� �1��� 1 ��1 �
ame (Phone
(Address) � �
( dress) (City) (Zip Code)
(Contact Person) (Phone) YJ� � � � � � V — 1 �
APPLICANT SIGNATURE DATE ' '
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fizture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEESCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Faxnily $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 't $ Building Permit #
"SURCHARGE" has been changed for one pLUMBING PERMIT FEE $ •�
year effective
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ . 0
The minimum surcharge for a "fxed fee" permit TOTAL PERMIT FEE $
is �5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid �¢ � eipt No. /'�
l9-
Date , ( �
Buildins Official Date
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245 /`� �g�
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 `� ,,�n
r� ►�