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Plumbing Permit 13. 0122
J W Z m N. h cc 'Li t ..,-..?... fi 4355 ul a 4 C mil W �c�Tewu�tn 0 a l d g r ► ❑ ❑ ❑❑ ❑ bpi �' � h re n ^t"t .. o CS 111 LL A C W �� J V Z _ Y Y y Z p 0 Z tr o L T 09 1 � �, � o V W U 0 W T Zu. W a. O U) i 0 O. :EXU/W 2 s d Z m" O W < 6 O 0 y w 0 2 H O ttii!! W a a. W w I" W k' a3 in a Q 000000 8 8 LL w /1 1 . � >Z� c w O < a tW� V z 0 O h aE 5 P a u. — 00 ow Z Z w 1- p Q 0 P. 0) !- t d N O ZCZ Z W 1 V V .J W ►- to Z — 0 Y 1 o < A U. b w oc W o> <�> <w a c N 0 O u.uu..u. =ti 0 0 c c li. U = d O a C3 0 ❑ ❑0❑❑ 0 0 ❑ 5 OI PRtp� Date Rec'd P CITY OF PRIOR LAKE PLUMBING PERMIT °' I. Blue File PERMIT NO 2. Gold City 3. Yellow App NO. Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID (N UM" Les 1 $ 1 efe (Phone) GIA (Address) J aAAAL, Tr‘‘ Of t/G � �� 9 5 6 APPLICANTS (Name) \\L3mo , \/b6A�\O \ � (Phone) �j 'Ca (Address) A x(11. �J (AC\ "(k 1\\\' " J )` VID (Address) (City) (Zip Code) (Contact Person) '1c `L) (Phone) ` - � 1 �� "k o APPLICANT SIGNATURE DATE 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 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"1. SO STATE SURCHARGE $ jr TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved P 54 5-0 Receipj N /© , Date By (1J 7 e Building Official Date f/ 3 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 _ n 4