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Plumbing Permit 10. 0499
OO n 00000 7 0 > / O r) n \ 0 73 0 0 0 jk / 0 m 73 m0 m n n � z �ER m m n o k§ 0 m m § § § § o q 33 q q ® Z -u B® §® 2 § 2 R d cn 0 z Oz z \ z - . z o 7 F,,_ n n 0 © r rn \ x ~ - F o ( `~ • e - n \ z 2 0 o 000020 z m m m ■ -a *C'V c c j �� -0% m 0 -1 0 \ 0 0 . >000 0 2 7 m ' o r -n oo z 74 0 % a o z .qt zx� z A r t z§ m 1 r- -0-0 P m r o \ 0 m 0 CI 0 �, 00000 9 o q z 7 2 2]§§ -C N' 2 ° E �� / > . - 0 , _gm2 K Fi § \1 55 II �a - -4 , ( K r 0 • � �� PR 1 Date Rec'd AN 'c CITY OF PRIOR LAKE PLUMBING PERMIT V tz, F ' rNN s SDI L Bone rile PERMIT NO . q 2 Gold City j0 / 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) r (X S 0 cvos+ Pc.- , N (;) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) �-k .r1 I J IC -V I Y \ d Y 6\15 16 (Phone) G T, - 49 ( -9 I c't U �/i (Address) asp S 1 U 11Q.excs \-- f UV APPLIC (Name)) ANTS WC C ' . (Phone) lccA -9 SC3 - ) %FaO (Address) '' c5 0 EX ()-0,4/0)' Biuk k i/v) N (Address) (City) (Zip Code) (Contact Person) R (ib l 1 (Phone) 9g, -931- - A n � 1 9( ,LI APPLICANT SIGNATURE (�/ DATE — APPLICANT PLEASE COMPLETE BELOW II uanti Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins Dishwasher Water Heater Floor Drain e 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 $ Building Permit # PLUMBING PERMIT FEE $ t / Sa STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ s gs l (Office Use Only) This Application Becomes Your Building Permit When Approved Paid 03 R - . No CG r OS-Zo, v / • // /6 Building Official Date DateCP • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372