HomeMy WebLinkAboutPlumbing Permit #13-092 \ 1 (� OOO�O� � � D Zn
� � � I� � tn�Z�n�n�n p � 0 v�
n �� °° � 3 m r'-� 3 =� z p y ��
b a o ;�; m N SzD� o =�
� m m a, Z � �-+ p
� r > � N � Z Z �5
�
� � � o n mm
� � � y o
� � � z �
r v 1
� m p � � ❑D�O�❑
� � n n 3�y�3�
� x z o v i;r�m=� m 0 n
9�e, "{ � • �ao���z � z =
� N � m =�xp � 3 „ m
� m c� � �,�go � _� � c
� �e" n c� o Z c c Z m
� � � Z �vv � G
�„° z � m
�
� A 0 �
h = m �
� � < �OO��❑ 1
v
� m �„„c� , ` � � m
� Z = ymm3� N
R. v � r �v � �v �
���o
� ��z�
� n ��f�0�r m
� m '� � z
'' -�+ r �
O � p ��� Date Rec'd
,� CITY OF PRIOR LAKE PLUMBING PERMIT
F
�
v
- '•+�yS��� i. Blue File
z. coia c;ty PERMIT NO . ` 2 CI
3. Yeliow Applicant �- �J
lease or ' t aad s' at bottom
ADDRESS ' • ZONIlVG cot�re,��
� 5��� C�n�� q ��i�a�-� �r� �� �a.�
LEGAL DESCRIPTIUN (office use only)
LOT BLOCK ADDITION P�
OWNER � ,^ ` � (Phone) � ��- I � � �
(Name) �i�/W '
(Address) � "��' J � m'�. GL ��.C.� . � �� �--
APPLICANT
(Name) A.�,nliance Connections Inc. �hone)
12850 Chestnut Blvd.
{Address) o��e;�e, Mlal 55379 -
(Address) - 952-445-4803 �cl�'� (Zip Code)
(Contact Person) �� t�' � (Phone)
r
APPLICANT SIGNATURE DATE � 2`"�
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
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
FEESCHEDULE
Industriai, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residentia(, New One & Two-Family $149.50
Residentiai, Additions & Alterations $49.50
Estimated Cost $ �� � Building Permit #
The Minnesota Statutes § 326B.148 U
" SURCHARGE " has been extended 'LUMBING PERMIT FEE $ � - 1 • �
until �une 30, 2013, �TATE SURCHARGE $ 50
The minimum surcharge for a COTAL PERMIT FEE $�Q�
"fixed fee" permit is $5.00
� �.,,� .��.�.��a�.�� ��.:�...� �.,ur Duuu[ng Permit When Approved Paid � � Receipt No. � 7 �
Date `��� By
Buildins Oit'icial Date
24 hour notice for all ➢nspections (952) 447-9850, fax (952) 44�-4245
.464b Dakota Street S.E., Prior Lake, Minnesota 55372
�; j; �ry;�;���nnol9�nsilqqA
`��ti8 1�n'- :,�;�:; ��c?$�!'
� ; cu� yiAi! . �:?r�olis�'2
�Ot�A-�'�.*� �a{�