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Plumbing Permit 13. 169
0o 0 000000 - 0 0 > 2 A 0 / °0 0 §IK kkk m m m0 t> k 7 m > c§§] X $ a� \ . q > 2 q � Q -4 P Z - 2 $ § -1 m z z z 2 \ / 0 0 Z 0 \ t 3 0 mm = r § - ) m '0 - 0 • r 2 O 0 ` 000000 ¥ m §m m rnr ®, ©� a q ¥ § o o F ., §E §c , ! z M , _■ mI■ -o 0 ` m § ° 7 f 0 3 Co g 0 '441.. ? • 2 m m g a®oo o■� m % o 2 ƒkk z § \ / � C - "' ' 0 I 7 \ 2 0 % § \ RD0000 i . ] z n]] - R. 0 ® §� §® • § \ z § 00 -2 q AU �q� 2 E C) m r ((vRifc 4' Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT iNNEsdo' 1 I Blue City PERMIT NO. �4, f z. cola city �� _ 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ft o Lp 7 Z ONING (oce use) `� n (office incj LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER EiYtthOn`� ��� (Phone) V (3 l.69 — 4IS' • (Address) I(p(p7H P iro Lake fr60 1 Lke ail 7 3 APPLICANT , / � n/ (Name) . ( 3 I I gnu (Phone) ' ! ti L-a (Address) i! , fill, 1► , Ni A,/ , _ (A. dress) (City) (Zip Code) Code) (Contact Person) % �pp a l (Phone) q(2)_ 1 13 `T APPLICANT SIGNATURE ilLI/ If DATE Feb. U. a' i 013 APPLICANT PLEASE COMPLETE BELOW Quantity, Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough - ins Dishwasher Water Heater Floor Drain I Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE 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 The Minnesota Statutes § 326B.148 Cost $ qij 3(� Building Permit # "SURCHARGE" has been extended until June 30, 2013, PLUMBING PERMIT FEE $ 4 q tyo The minimum surcharge for a STATE SURCHARGE $ -r-50-5.00 "fixed fee" permit is $5.00 TOTAL PERMIT FEE $' g— . 50 This Application Becomes Your Building Permit When Approved Paid s sy s6 Receipt No. Date 4 By Buildin¢ Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372