HomeMy WebLinkAboutPlumbin Permit #12-0909 y o❑� c� 000aoo � o a =�
n n� �°� 3 m��� Z � � m0
b D o ��� 3 � 3Z-� � y n-n
� A y m y 5� o a' o�
�° -� -� � � m � Z �
10 , f/l N A Z = ` Q�
� � O n Z `�I n�
° ' z -� � m m
� � = 7 �.� 0
� � -
_ �n � v
� m � � � DOOOO❑
'� x �^ m m m�
� �' u�, � � ���
� 0 N g m �Z���W m O � A
3 n z =_ �i ; n
� �' o ��g$ � a � v
� � � z � �cc z r
�° z � m �v�v O o
� � �
= m
� C n �
� y � �0�0�0 �
� Z X ��3� N $
� C � � y m � y� � m
'� Z 4 m�n 5 � c
� m ��m�
�
� ,��� �
� 4 pR[p� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
N 8.�3.IZ
�
�
��s��� �. 8�,� File PERMIT NO.
x. cou c�ty l Z
3. Yeliow Applicant !
C88C OT t 8IId �� b0[�OIII �
ADDBESS ZONING coe'ice use)
SS �/ �'I O��-�� c �� S �=
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �/ /�
(Name) _ � � JC.J� c, S r � /l.�> � �/G � �'� (Phone) ��Z' `T 7 ` `�g
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) one)
APPLICANT 3�GNATUR� DATE �8 � �' �.� �Z�
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fi�ture uanti T e of Fixture
Bath Tub with or without shower Rou h•ins
Dishwasher a eat
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e ashin 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 joh cost with a$49.50 minunum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 st $ Building Permit #
"SURCHARGE" has been extended �� �
' until1une 30, 2013, PLUMBING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ S U G�
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ _
This Application Becomes Your Building Permit Whea Appruved Paid �� �� Recei o. /��
t0
Buildins Otficial nat� Date � j� l Z By
24 hour notice for all inspections (952) 44?-9850, fax (952) 447-4245
.4646 Dakota Street S.E., Prior Lake, Minnesota 55372