HomeMy WebLinkAboutBuilding Permit 11. 1259 o _ \ n 000000 7 0 > %B
O X22 -n�'n 0 t 0 - o -<
= n 0 C zz z m m0
k r\ k m k m - � c k 0 z 0 /
m r ® ® 2 $ ao�Q z3
w§ \ 01§ 0 2 § 0
® t * a
7 2 § / 2 o %
@ m 2 q m
■ n z 0
Pi o r 0 . LA
/ ' -n 13
7 m 0 0 000000
m § k q z mr >mr
\ q § D/ } t m7& n
» k ? m ]$77�§ m 33 0 0
2 \ m ) q >000 Q -/ m
:1 m m r r -n oo , c
%
0 \ z > cc § r
t z m • . r �: § c
2 ■ m ' �� 7-
Q
c
m . 1. r OE000 .. o ®_ m ��nm. >
% » 2 ' �K� \J ig
a.
0 K�� �§
o &a§mK= --I j R 2�� K
ƒ
< �i §
4
rR Date Rec'd
i �C CITY OF PRIOR LAKE PLUMBING PERMIT
/11E Lti
z3 ei,
+4,1vESO'o
. Bme File PERMIT NO. f �' / Z5,
. rota c tr C'
(Please or 3 Yellow Applicant
( type print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) L') Pi__ T=12_ -5 c_i (Phone) q (� 7 —? ` l
(Address) 1.�jE6 00) c-t Ur1 `: C , 1 or Li ri 1 I---/ i x;19 72
APPLICANT - ,
(Name) - ' t " 1 i _ S C i . ill/ r , 1 k ' / ' c - N l t _ i _ (' i v – 0( t t>2 V . , t c ) ) 0 + ) (Phone) y 3 1 ( `S - 4°
(Address) 5 2 b l T1 C ftl3met) f l - ' . 1 K ) (.) 1 f ( C / i / 1 A_ `5 6 I
(Address) (City) (Zip Code)
(Contact Person) "V E4\-'I L- > (Phone) ` ?
�
APPLICANT SIGNATURE c ° 4, 7 2 / '7"7 DATE 1 / ) / '5 /
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, Connmercial & 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 st $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge for a "fixed fee" permit
is 21 beginning July 1, 2010 • TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid sq 1 . 1 . ) Re i No. 6 vt. 7 7
Date l z'
Building Official Date ( f
/
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 '
4646 Dakota Street S.E., Prior Lake, Minnesota 55372