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Plumbing Permit 11. 0257
k \ -k ■U. cc 111 E *ww < 0 2 5 5 0 k % J � a aa 2 iii t 02 77" 0 2 `d g w0��0 ■ ■ 6 ri r 00000k %. w 2 . o § § § w 0 ..._.„ 2 cv / § §tea I @ k o q M �� z o q I b cd 2 ti — SZzk ,j Lu 114 C.) 0 01 IL' I‘ a J z § ' � S� § �S m� ww rj X N„. a ■ ■ ■a■ ww ■ OOOOOO §0K % All a a u. gE 2 , 2 y ■ « © Y § NI z �. g z 5 P 0 u- v % ili k 0 0 g w I § IN 01 - z . . § a « t- 4 % a§ z ��� \ _ k 0 0 u 2 ■ k §3 m« . � §\ v / ti 0 § 0 uu 0 _ 0z 0 0 a. 000000 0 0 0 3 1 Rio `" Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT 4. (5' ( I .. x MINNESO ,. Blue File 2. Gold City - PERMIT NO. 1 7. 3. Yellow Applicant + (Please type or print and sign at bottom) ADDRESS ZONING (office use) q-4-S Sridle IkIc13eIV Nfr LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID (ONa NER W Ted v rn` (Phone) 9 s;-'11-10-5717 (Address) OWflt., Champion P1ufnbing APPLICANT # 61770 -PM (Name) 651 (Phone) 3670 Dodd Rd. (Address) pagan, MN 55123 (Address) (City) (Zip Code) (Contact Person) Y.,ris C), (Phone) APPLICANT SIGNATURE DATE /-1_11-0 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Dishwasher ` Water Heater Floor Drain ater rottener 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 The Minnesota Statutes § 326B.148 :ost L ,s0 `1 V Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit is beginning July 1, 2010 TOTAL PERMIT FEE $ S, O This Application Becomes Your Building Permit When Approved Paid 5 4 + 5 R ipt No( 5' Building Official Date Date 1 5(1 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ' o ea c,pr