HomeMy WebLinkAboutPlumbing Permit #12-0765 y ❑❑� C� 0��000 = O o N�?
� � � � O N�,g�noo �
n n � ��� 3 msG; m r" m no
� � � m m y m N��=DZ � � N �v
�° � � � � N m � z �
ti a ��� � Z O O�
�i o � � z m x
m
Z �O �
S
� � n n � ❑ ❑ ❑ ❑ ❑ ❑ i 1
m m m 3�y��� 1
� a, ° ° , rn �c ��c
`� °) x3�mx3 � c� � ui
� o � � V � „ 0D 70 � � �? m p �- c�
� C N � � Z� � 3 x =
�° n � p � ��n O O ;o =� � � C
�� o z 4 �, z�� z r
�,° z � m W' � o 0
�� � �
�
� C � ~
N m I ❑❑000��!
� � � �
I �I �t n ( -�i
� � �
R• C ' r���� ^ m
�' D � � �. m�S�S• �'
� Z �' �� 1
� >mm
m �'���� � i
� � ' � m
s
� � pR.ip� Date Rec'd
�
CITY OF PRIOR LAKE PLUMBING PERMIT
�
V
�� �. B�Ue File pERMIT NO
2. Gotd City � • /� ` �/� �
3. Yeilow Appficanc ��
ease or ' t and s' at bottom
AD � RESS � � �� ZONING (otrt'ice use)
S ��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � l( � . �� .
(Name) (Phone) ���;,���--=
(Address) �� � � � r � '
APPLICANT a
(Name) # 61770-PM (phone)
(Address) 3670 Dodd Rd.
(Address) ' (City) (Zip Code)
(Conta.ct Person) #--t.C.t, l�l (Phone)
APPLICANT SIGNATURE DATE — "' �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture nanti T e of Fizture
Bath Tub with or without shower
Dishwasher Water Heater
F1oor Drain a er o ener
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-Family $149.50
Residential, Additions & Alterations $49.50
� - ` $ ,a.6��. � Building Permit #
The Minnesota Statutes § 326B.148
"SURCHFikG�" has been exier�dec; pLLJMBING PERMIT FEE $�
until )une 30 2013 STATE SURCHARGE $ •�.330
The minimum surcharge for a TOTAL PERMIT FEE $���-`,�.--
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid �� / H l Receipt No. /'� � Q
`y'��.� �� b ,/
Date �/�� / Z By �
BUua�e ot��i8� nac� �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Mianesota 55372 �
_ :. v.._ �
t
, . i . i ' �
. _ �- _ ' . . . ; . ,
�, . ,. ,
ti