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Plumbing Permit 11. 0684
5 0 0 0 000000 11 0) E k ■ n 00o . 0 wm K�0 0 m m � § r 22 q m 2fE5Ek§ z § q � k t 74 2 §Qq P � § w » ■ ® 2 © . z ■ q # $ ] . o k m z2 0 k §k hi k r § 7 m 1. % il 13 k �, % m 2 0 § O00000 `, - t.7 1 x _mm « a - «s . �� 0 ZQO OC �CIc h.. % 03 PO x § ■ § 22 § m 0 ' 0 ki U) \/ f q � z zxx z 27 z I � N, q § 0 r- 2 xi -4 � z \ r t. % z rt m \ % ''44 1 r'V 13 P 0 rn ' m _ Lki A. o 0 ! < . 000QO � v. 2 B 2 . § ® ® mm 3C ® � ;P Z ��� 4 PI K A, �■ - � 2 � . v' B In P RIO R Date Rec'd CITY OF PRIOR LAKE PLUMBING PERNIIT 7 27 3 . Blue Applicant 1 / e i _. 2. Gold c; PERMIT NO. 3. Yellow Applicant i Meese type or pint and sign at bottom) ADDRESS ID 3 €4- &s Tss { ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID WNEB WI eXASillitdiCA (Phone) (Address)' Q,0/11, lJ pC c IrynAz APPLICANT \ _ (Name) * - l ? 1 t hone s/t.a -41,1c (Address) c> 1, A t Blvd. „. (ct,...17 i, ` 1� 1 S 3S O. (Address) (City) (Zip Code) (Contact Person) (Phone) (. 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 The Minnesota Statutes § 326B.148 E s t $ Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ _ qq, 5e1 July i, 2010, until June 30, 2011. STATE SURCHARGE $ .50 0 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ Sit ST) is 55, beginning July f, 2010 This Application Becomes Your Building Permit When Approved Paid 5+ S U Rec /t No. / 34,74_ Date U U — , + ( By $gildin Official Date ' 24 hour notice for all inspections (952) 447 -9850, far (952) 447 -4245 4646 Dakota Street S.E., Prior Loko, Minnesota 55373 Rti(0.5