HomeMy WebLinkAboutPlumbing Permit 10. 0307 t9 Q -
Z f-
P .-.1 w re W
F- U U
ggPA Z W� U 2
r N. z
(7 W W N C7 Q 't
Ilf 0 W O O U� U z
N ) W
J CJ ■ 0 O
2 W = cc Q N O
o
W O mo. m C 0 oC
li H Q O LL _J 1 O 0 W Q
000.1 F' a`i a P. • ' OO
O W ? — ==ZZ r U c a o
O 0 a m=w 0 z x 3
f Z m 25m a 2 U
III Ili U w Z c r y
4Z 000000 ,v • a
CC a
x
' ,a 0 a o
0
U
- 0 2 aa� co s
w
O O z w F r d 3 1, W
O z Po-
a z Q v v w
Q.... CO 0 - ,C1 — Z w Y w w o Q q
Ow nn z O= �zH 0 re 0 0 U Lj
u) O O OO�Z �iv� S U a
o
U? Q O a 000000 0 0 0 E
PR /0 Date Rec'd
ti / \\ \c' CITY OF PRIOR LAKE PLUMBING PERMIT
NNE5 °�
I. Blue File PERMIT NO .
2. Gold City 10 30
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office
'" / use)
/ f7e19/11t(U► ll � ///5 L SE - %O4 /4 11411
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER t
(Name).SU _ _ (Phone) 9/93
(Address) /9.S /9 - ki /ti
APPLICANT
(Name) ‹.-Gt Z/9 1V/)6- „s / / t)/�-p / o
(Phone) 9
(Address) //,3 144 /uxL-J ) %c J . t . / / ?4/Ct 37 D-
(Address) (City) (Zip Code)
(Contact Person) (--gd2 N /Uf_ g 1/4,.5 •ey€ (Phone) 93-c9-
APPLICANT SIGNATURE 94e.) DATE 1. // -7 /l v
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 / (� zcit ) 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 $ �r //` �Z
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ OD
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid _ Receip o. 6t3
Date . (d By t¢
Building Official Date 't