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HomeMy WebLinkAboutPlumbing Permit 12. 0378 / El 0 0 000000 0 > g o A o o K O ������ § t R � � k / k k m c � � & k\ q §9 % t q\a Z K \ 0 > § $ )� �� Z Q ¥ G 0 x % \$ k§ k z 0 ■ u z m ,_.•••• f © 2 -CI o § r ] 2 d r z \ m m -4 : r v .. C \ rn / k k LA `� 7 m00 000000 i x ! m $r rtmr _ \ k f § \�2m -ti 0 ■ 0 \ 0 \ 0 r -n0 \ \ 0 $ . z 2 / . q z 70 K r o m m •} » / $ } z \ . \0Oeoo & R. > § . >II § 2 �� § # mmI k� ,gym % § m �� W / m � »nn % 7 m -n q � z m ®r 0 c 4 ) 19,.c Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT H x v IvivESOc I. Blue Flee PERMIT NO . 7 270 2. Yel City / Ls 3. Yellow Applicant I 4 ..1 (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 ( 0 3 19 1/i c i ok_ atinfic LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID ((Name) v vl (Phone) 95)-- ! 41 91. (Address) 1 03/ VI (t ' I O-- C- iL-47VC-. APPLICANT ,� Ap p4 i !.'1..fl CL' C acit l/o r iS (Phone) 1 1r i lq - S . LM3 (Address) )313 DGu a.. C it 3h( k _ 7 )3 -- 11 (Address) (City) (� (Zip Code) n^� (Contact Person) j (Phone) fs- 1 14 1S x 6 APPLICANT SIGNATURE -L, ' Segaga DATE 512412.-- 0 1 i1 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 1 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 lost $ Building Permit # The Minnesota Statutes § 326B.148 G "SURCHARGE" has been extended PLUMBING PERMIT FEE $ S9 until June 30, 2013, STATE SURCHARGE $ .50 The minimum surcharge for a TOTAL PERMIT FEE $ 9j. 5 "fixed fee" permit is $5.00 This Application Becomes Your Building Permit When Approved Paid / J -Z + Re , No. j --- 3 (7 `r C1 ' ,J Date ` 0 / B Buildine Official Date • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372