HomeMy WebLinkAboutPlumbing Permit #12-0908 � O O� n ❑ODO�❑ � O D =n
n �� o 0 0 3 y z��°o ? � � A�
b D � � � � 3 �� Z � v� �"0
M r m m u, m y 5=yz o u, o �
�e �� a Z�v o�-+� zo
C � p�� N � Z = � ��
� � � D O z � m x
0
� O � Z �
-� � � �
_ � � �v
� Z � n n -�❑❑O�❑
t ' 1 7 x m m m m� - ,
o� � N v o �c ��c -.
� a g �3��xW m � y
� C � m � � D� 3 Z m
�° n � O r�00 � � � v
� � o z Z�� Z r
� � m ��� � o
z
� A � "�
= m (J
o I
� y < �❑❑��❑ C
� Z z >��OZ� � � -�i
R• C 4 � '�r���� � m
D m����
� n Dmm=�
� m -'��� -,
� � �
. �Z � m
D
h
� ,� pRlp� Date Rec'd
H �
CITY OF PRIOR LAKE PLUMBING PERMIT
v
�5��� j /�
I. Blue File PERMIT NO . / ��D Y
2. caia c�ty L _
3. Yellow Applicant �
lease or ' t and si at bottom
ADDRESS �� ZONING �or�� ��
I rr'i
LEGA.L DESCR�TION (oflFice use only)
LOT BLOCK ADDITION PID
OWNER /�. -� 2
(Name) (Phone) �/�r�[ ��"J���
(Address) j � � �
APPLICANT
(Name) Appliance Cc►nnections Inc (Phone)
1313 Dan�t� Cr
(Address>
� (City) (Zip Code)
95 ,5-4803
(Contact Person) (Phone)
APPLICANT SIGNATURE ` DATE �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Ffacture
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 sitak Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Tailet Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residentiai, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 t$ Building Pe it #
" SURCHARGE " has been ex±ended pLUMBING PERMIT FEE $ �
until june 30 2013 �TATE SURCHARGE $ j
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid � �� Receipt No. � 7 ��
7
Date f,1� � L BY
Buildins Offleial Date �/ •
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E,, Prior Lake, Minnesota 55372
_ _ - _ __
�:� . .�: _ . . . ... . . ... . . ... . . . � .. .. . . .� ' . . . � .� . .. . . � . ..�: ..-. �., . :; ...� . . . .
• s " . .� . " ° i1 z`t��T��� ° '�
� .. '°; ,�.• r _ .