HomeMy WebLinkAboutPlumbing Permit 10. 0397 z �
z o 44
w
O Z U UW
00 u u Z ?
-1-c \..l
1. 2
w O U CC LL U' ; (n
❑ ❑ ❑ ❑ ❑' v
w O
v
li U. \ a s m c Z W
0
1 2 _ Y Y Z O U U 0.
V
• 19 1 H (3 00 V P. c w a. ' c
7�. w Z a Z _X1Z ` � O a. 3
v U \ 0 w mcertrtco u) I- AG
co \ 0 0. 2VHfi��U t^ w w in X u`
,� W w
z
�� a3v� '�
•• i 0000❑❑
LL
w O Q 0 Y ° oC
U 0 LL F 0 w a
P z U ui T. a 3 I
Z a ~ u0 w
E N p z Z W Y Z Z o Q
O V w W w O : 2 ?z ► w - V U a U U
a 0 z o o ?emu, p 3
C J ❑ ❑ 5
5 ? a O a 0000❑❑ U
0.4 p RI0 Date Recd
CITY OF PRIOR LAKE PLUMBING PERMIT
l ~
doivNES �. a>vo pi4
2 , aew a: PERMIT NO. / 3 / ' 1
3. Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING (oakeuse)
61 Sam w c
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER `�/U-,/ (4 0 e P m-2-'- (Phone)
l� (2� 7 o8
(Name)
(Address) 1' (‘)f G Sa L.9 c.c S k
(Name)
APPLICANT
C2 ur C (� t, e t (Phone) �3) 2 S 3 ` 3 eo `/
(Address) 2( 0kZ �jt to v\ rOe S fi C -eCcv- cCO t \
(Address) (City) (Zip Code)
(Contact Person) C tt-ci e t R c, -...-J (Phone) O&J' 7 s 3 `" 5 qc' ( I r
APPLICANT SIGNATURE v DATE // y f r e
APPLICANT PLEASE COMPLETE B ELOW
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 f Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water C1os t (Toilet) Other
. i) .+ U a Jbi. ( gyp^, j , o t'\
( FEE SCIIEDULE
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 $ OO ' Building Permit #
PLUMBING PERMIT FEE $ L{ Gj
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ qa , d�
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 6-z) a) ipt No. 62.5D _
Date c)...6✓ Co
Building! Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372