HomeMy WebLinkAboutPlumbing Permit 10. 0823 5 ❑ ❑ 0 0 000000 'n 0 D 2.0
v 0 0 0 0 -n z -n m -n O v v
n v 0 O 0 0 'S mAC� m m m n0
b D o m 7J x 3 r 3z-i z 7J N O
to ±� D n z O z x
iii cn -I z O
• 0 I � o 0 z ��
D 0 ► mm
to o D z 0i
x T 'O '9 0 ))
z • m m 0 0 000000 ---
m m m m 3�v►*3v S l
o z m m 7 0c -
10 0 � x3 m x 3 v o '' co
% p m m mTMMmT m 0 • 0
° � � , C m -i n � Z 6 p p 0 3 z
--4 m
7o 0 5 / r mOO z - ?1 m
-{ o z Z CC z r
O z m � vv O my
A
• i
1 73
C -
m
c 0
0
7 '0000
ti z z c1n \ `>
R. D 0 (m m3 ) m
t''' n D mm - ?I
m Ai 1
• a ., r m
r 0
Q
0.7/_,G. Date Recd
,.., .,, L7'4 CITY OF PRIOR LAKE PLUMBING PERMIT _,:,,,.
-:.,-.:*
-� �:;�_ °gym
�jNNESO�� 1.91ue File
z . =w �,,,. PERMIT NO. /0 e 2, 3
3. Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 y q aci TPnbe9 1 ool e. C;urc,lx. N
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O WNER 14(
V--Q\ \\J\ jirciA ) q WS LP ��G-
"' � 1 (Phone
(Address) � `--f of a"G t t I I cxri k N 5 1 I VU ' t_o
APPLIT \ \ 1 1I.1LY� 0 C q L) Li ` (.,) L H LI
(Name) CAN 1�/ 11� � lU � l t` �JIJi � 1 �� (Phone) .\l x L ) v I
(Address) \ 421) W , 1 Y \ COL!) ' ���
'' �� G
(Address), l � (City) (Zip Code))
(Contact Person) ) AA l� 1/� 1 IA .A.) V kne) oict 1/A 1 -1 1 -/ LJ `7
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough - ins
Dishwasher 1 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 - Fancily $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paids 1 - 0 Rec pt o. 6,0
Date /? i . By '
Bulldlne Official Date °
24 hour notice for all Inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E,, Prior Lake, Minnesota 55372
(--
.■••
k- 1
L_.
•