HomeMy WebLinkAboutPlumbing Permit 09. 0804 z_ w
Wwx W
@�q0 w
« ®
2 � ° - >
oO§ §m 0 2
o w 0 0 § z b
| 000ee &
)� u R
§ m /
§ 2 ) �z ) / §
I m oo o @ b {
w , Z B 2_m ?27 § c il
0 0 a 2 mwwmi a z 2 (
§ ow § § u oc g e o
a2§ w w E w ® LU 000000 } } 0 $
1100) re
r e w w o} 0 DI u
o ` ® R /
re ° o
0 z z «
W O o� 0. z
I \ v � \
R 2 B � k cc k %
~
0w W w z 00 wwzq 0 o\ \ 0 §
5 § K § oo E
Q� < 0 a 000000 0 EO /
U 15 t ci
AN CITY OF PRIOR LAKE PLUMBING PERMIT
C C O O A U OCT 0 6 2009
U t�
kNE5D B
1. Blue File
• 2. Gold City PERMIT NO. q (
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5(act Pox-r Cyr (-Lk _Se 553/a
LEGAL DESCRIPTION (office use only)
•
LOT BLOCK ADDITION PID
OWNER •
(Name) UC.v2 -. \\G55 e- (Phone) c t Sa - 49b 71 0) y
(Address) 5 b a 5 N.t k.v0e■.3 C rc-L 5 £
APPLICANT
(Name) CULLIGAN WATER CONDITIONING (Phone)
6030 CULLIQAN WAY
(Address) MIN ;g 933 -720® " TONKA, MN 5540
c (City) (Zip Code)
(Contact Person) (Phone)
1
APPLICANT SIGNATURE y 0 — - 1 _ DATE 9 - 01
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 $ -QQ• 0 0 Building Permit #
PLUMBING PERMIT FEE $ 49.
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ –50t00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 0 0 Receipt No.
7 � –G O04.
Date By
Building Official Date /0. 61 • 07 c •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372