HomeMy WebLinkAboutPlumbing Permit #12-0552 � o ❑� c� ❑❑a000 � o a =�
� � �� O u, �, _„ o�, o ° v v
n c� � ��� 3 '�� m � m m0
m � �
t� � o m m u�i m N rs z °= p � y 0�
t� �: ' � - m 0��� Z O
ro , n tn (/� A = = CV ��
� ° i "� z - �i � = m �
0
� m
t� O � Z °�
� � � D �
� z � c�i c� O❑�❑�❑
m m m m 3�vrn�;�
� � N v v �c���c
s; mx3 � c� tn
� a y � m „W���W m O c�
� � � `� � s� � 3 � v
,�,� n n O rT00 � =1 C
� � o z _ Z 7C 7C Z r
O Z � � r- '� � � O
a A O -�
�� S m N
� C O � r 1
y m ❑❑❑DO❑ �
'�1 Z � ,n ?1 ?1 (� � �1 �
a�. D c ymm3� � m
v r���
�' a m�5��
� A Smm��
� m �.�� � �
� y � - Z m
" r �
� PRIp Date Rec'd
� � 9 CITY OF PRIOR LAKE PLUMBING PERMIT
� x
� �
�
l. Blue File pERMIT NO . �
2. Gold City
3. Yellow Applicaot � � �
lease e or ' t and si n at bottom
ADDRESS ZONING (oflFi�e use)
2�-(of 5tb r��f �a`�'h
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owivEx j�� o� -�jZ_ 2�5
(Name) VT/Q� ���/ (Phone)
(Address) ���\ f N �J ,� J p�
APPLICANT � / � �� , � ( �
(Name) ��� (Phone) ��J rl I�, �1 �'f
�
(Addxess) ►�— �
(Address) (City) (Zip Code)
(Contact Person) S (Phone)
APPLICANT SIGNATURE DATE ��� � 1� �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fizture QuanH T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher 1 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
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
�ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended pLUMBING PERMIT FEE $ �
until june 30, 2013, STATE SURCHARGE $ �. (��Q.
1 he minimum surcharge for a TOTAL PERMIT FEE $ �
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid Re ei t No� / �
10
Dat r / M /
Buildine Official Date �a� � V
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 �
4646 Dakota Street S.E., Prior Lake, Minnesota 55372