HomeMy WebLinkAboutPlumbing Permit #12-1239 y ❑❑� n OOO�O❑ = O � ZA
� C) A � O N �1 Z �1 �t �1 �
o n � ��� 3 m�c�c� m m m r^ O
�p y A
l' r O �� y m y � fN 0�
�, ,� ,� a Z .� � � c� Z �
ro� �> v�, -� � Z� Z
e m o� D N-� = 0 70
� ° y Z o Z "'�
� � z �
v
� �° o o �
nn � OO�DOO
'� x . m m m � m�
� '� a, ° ° p�
�� '�
� p t � m 1 ��oo���c° m O n
` C � � � Z�sx G�i 3 Z V m
� � 7 Z � � r � Z � I C
o O oo � >
Z � � C�, � �v� O o
� A � �
= m (�
� � o U
� u�i m ❑OOO�❑ ��
� a z a'-'AO�C � -�' �
� � � z���� N � N
� Z m �5� o v�
� n Dmm��
� m „�,� '� 8 � �' e
~ �� � m
O 4 PRl`p� Date Rec'd
,� CITY OF PRIOR LAKE PLUMBING PERMIT
N �
v
�r�
�. B��e File pERMIT NO.
2. Gold City /Z i �Z3
�. Yellow Applicant
ICdBC O! � t SIId Sl St LOlt011l
ADDRESS ZONING �ot��,��
� f�� � JV� �� .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWNER �./1 � G Q�� � �.1�"c.c.Y 1Z— (Phone) �c.X� � �JiC� - Z �
� — L
(Address) � �,(�(� � ( � ���� �.
APPLICANT , � r
(Name) (Phone) l� � - '�'�� � �� ' ��� �
(Address) � ' �
(Address) (C (Zip Code)
(Conta.ct Person) T� � (Phone)
APPLICANT SIGNATURE � DATE - �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fizture uanti T e of Figture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Baz 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
Estimated Cost $ Building Permit #
PLLTMBING PERMIT FEE $ � .
STATE SURCHARGE $ � -, (�.�
T4TAL PERMIT FEE $ �jl,�. C�
�oge� u� oo►y>
This Application Becomes Your Building Permit When Approved Paid S� S Receipt .!� 7� �'�
Date� � � � ,��' � � By
Butldine UfYiciai Date �
24 6our notice for all inspections (952) 447-9850, fax (952) 447-4245 ��
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
� . , ��� _ .. . .: � � �.,
, . �. �.
:., .,,��. <.�,, ;.
.
.,o,� �