HomeMy WebLinkAboutBuilding Permit #12-0650 � ❑ �❑ n ❑OO❑DO � O D zc�
y (� (� 0 N ?I Z 'R �f 'rl Q � � � �
p A o ��� 0� �.� 3 m�c3z0 m � m n,�i
b � � m � y c. m y ��>� O N O �
r Z 'o _1 z —
1�0 ;� � D � N � Z z Z �
ra O c� . .i O
� � n z o � . Z m�
� � � � � �
_ „ � � �
� Z � n n ❑❑O❑❑❑
' X m m m � mrN�3�
o� -� N o o �c���c
� o Z� � CA ;+Z��o z� z x
� C � co � Z� 3 m
� � � o , �„8 g�_.� � �
� � o z z��c z r
o z � � �'° �v o 0
F� A �
= m g �1 �'
O
� �
y < � � �DODOO �
� -'
(n ^ o
� Z z � ���OZ� ) m
� y � G � Q �'
�` A mD�sy�
� c >mmZ�
� m � "Z��� �
� � �
m
� � pRip� Date Rec'd
N �
CITY UF PRI4R LAKE PLUMBING PERNIIT
�
�rN1VES��A '. a'� '�` PERMIT NO.
2. ddd Crty I � . �,����
3. Xellmv Applicam �.�
CdBC OY 8tld 8� at �IOth)nl
ADDRESS ZONING co�'ice use)
J`�� 7 �t1�'�S Y` �
LEGAL DE5CRIPTION {o�ce use only)
LC?T BLOCK ADDITION PID
�"rr� �.✓nr �n�✓`1 ��r� ���� ���-�f 57-�7/��
cAaa�s> �s es �' � t''a�' �.-a. C�M 1� ,S s3��
APPLICANT --�`'' t r
{Name) 1 M l.lGi � 1 l�( ` (Phone) � � - ��� .� � ��i �
(Address) �� l- Q � � � �S O .�s.3 �o
(Address) {City) (Zi�p Code)
(Contact Person) � L-1 V�l I�CJ ( V h {Phone} g� m�
APPLICANT SIGNATURE DATE C� a
APPL C PLEASE COMPLETE BELUW
Qaanti T of Fiatare uan�i of Fiatnre
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
La.vato athroom Sink S#and Pi ashi Ntachine
Laun Tra 1 or 2 co artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Back�low Assemb Test
Baz Sink Lawn S rinkler
Water Closet oilet p��
FEE SCHED�JLE
Indushiat, Commerciai 8c Multi-family 1'!0 of job casi with a 549.50 minimum Residentiat, New Ome 8c 1�vo-Family S 149.50
Resideniiat, Additions & Alteratio� 549.50
T'he Minnesata Statutes � 325B.148 .��� s�j_L3� •� Building Pecmit #
"Si1RCHARGE" has been ch�nged for one
ye:ar effective PLUMBING PERMTI' FEE $ ,�
.Jut,y i , 201� uniil June 30 ?A! i. STATE 3URCHA.RGE $ .50
T6e minicau� sarc4argt tar: '•tixed fee" per�nit TpTAL PF.RMiT FEE $_���^
is �4, �yaiag July 1. 2010
This Apptication Becomes Your Ba�ldi�g Permit Wh�n Approved Paid r�( � R ipt No. ( �,p,
�� `1 l0 Lr,t_
�;� o� na� ��t. ?/ 1. ( �
24 hoar RoNce for sll inspectioas (952j 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lak� Minnesnta 55372