HomeMy WebLinkAboutPlumbing Permit 09. 0873 3 ❑ ❑ Ci C? 00000 0 2 0 > Nn
10 n 0 0 cn�Z mmm Z 0 m�
O O 73 3 M>c3z� m 73 v orn,i°
b o ru m 0 t m Z Z O z Z cn '0
t'n r m m 0 Z v = 1O-Dio =�
)2 n -I - D -.1 m co n
� O -n Zo 73
c z - z c mm
+' n O
a m 0 0 00000 0 m t m m m v ■ ' ^ �cN��c
Z o v A
M A , T W7) X 73� m 0 n
0 m , 0 D m 0 0 G 3 z I m
m m 0 ' ` r ❑OO ;n =1 P C
Z T
x 73
O ❑0000 I ' r `: 1.. v
m � n -nnm G° ,C>
'1 Z b ' :U � O � . m
Z
tn z P �m m i .`
R1 k 0 - z m
N
-1 r
c
1
a�
Date Rec'd
oi � t
_ RIp , r;ti - Y e CITY OF PRIOR LAKE PLUMBING PERMIT 10.1t1
y
rNNESOO I. Flue File
2, Gold Ow PERMIT NO.O� 0873
3. Yellow Applicant i
(Please type or print and sign at bottom)
ADDRESS s.1 '6 i 3 M <rh•ti c Lc (._ 6 ZONING (office use)
P■,. ‘.c% (.c -Ie..._ SS3 2—,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER S\1eve c kcj Res cf6 - -L.0 %i -C V5 -2 --
(Name) hone (P )
(Address)
APPLICANT c6---'3C (-� Z
(Name) e i n/C sic- t 5 7U��'/ - I`1 — (Phone) cj
(Address)
1 I s MT 6'V, 101 Q t.k; 63 3
(Address) (City) (Zip Code)
(Contact Person) . _ (Phone)
APPLICANT SIGNATURE ,,e DATE /V 72-6-0 —
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
;r
I a r e . Closet (toilet) , Other 4
FEE SCHEDULE
Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations •
Estimated Cost $ 06 Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50 ‘ V ( 4 U.
TOTAL PERMIT FEE $ t 'L c S - o
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 9 Recef'p 6 7
Date /, / B}
BuildinaOfficial Date /U. zb. or
24 hour notice for all Inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372