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HomeMy WebLinkAboutPlumbing Permit 10. 0033 I S \` n 0 0 0 0❑❑ D v m0 ❑ ❑ ❑ O cn - n - -n p z ° o b f N \� z o o z 7' m 73 n n 73 XI 7 16.. �. 3 m�°3z� z CA 7-1 - p\ 73 73 7 r R i z ° y O Z ht r n n D . Vl�, All —I m o p z 71 tri 4 a N \ -� FP: z z o rTi ro ( � ~ c f x o 0 `- 1 Z 0. m trj o - z -a tzi c = o ! , 0000❑❑ \ k '‘' ''...k 4. m �' x m n n mr >mE cn 'C Z W - > ZS0 _Z 7' Z o 0 0 - D n z z 00 p z m \ r '1 \ rn • m ,11 ,` pip al ♦ 000000 U1 r `y m��_° � (Q D mmZ- n F1 ( 1) 4 —Ir Gt _ ni VRI V Date Rec'd ,. y . ie CITY O F PRIOR LAKE PLUMBING PERMIT 0 '/VNES V I P 1. Blue File 2 Gold City PERMIT NO. I b 0 b3 . 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS c� ZONING (office use) s0 isd. 15 /ate K� 0,„ - LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) � "` + clv b 6) B eS W eti.cu,✓ (Phone) -/ y0 -' c� ©'70 S (Address) .4 U APPLICANT (Name) , �in...estsix PI1' r b' Y + (Phone) ° tS'd ` ytic/ (Address) 1 `f 3 fil A w - S / vt4 /0 S - 3 - 3 (Address) (City) (Zip Code) (Contact Person) /Vet/ (( , ((w�( (Phone) 4 S - APPLICANT SIGNATURE �` DATE / - 0) z i a 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 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 Estimated Cost $ / q. r3 Building Permit # PLUMBING PERMIT FEE $ '/9 ,5 STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ * S©, ocv (Office Use Only) 1 This Application Becomes Your Building Permit When Approved Paid a R - et No. 5 3 / CJ• Z Date/ `/ %, Buildine Official Date Dat ! , ' / 1 y • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372