HomeMy WebLinkAboutPlumbing Permit 13. 0464 n 0 c
y ❑ ❑ p 0 000000 = 0 > -
cy 0 a 0 0 0 3 o
. (J) ,,
=i,zccn e0 z m ° X m�
O G r a XI X 7 3 m rc3z -+ m 73 FA 0 m
tr, r 0 m m z �goz Z 0
5 73
�+ r - Y Z v 0 00 O Z O
01 D C m ) Z O Z
c m ad -) 0 El) F,-) (n -I Z 0
�o G Z-4 Z T m x
rn O D D A \ ,
0 (^
Z x 0
0000❑❑ Cn
z O m m 'n W XI 73 z°°3 21 0 n o
o * m m >000 0 3 - Zi z m
. 0 n O r -1 O O -1 7 (t C
ty -I o Z Z 7 7 Z r
2 m r=
O n \ 1 r
C O `'V m m ,` ,00❑❑❑ % , z c)mmnm °
R. o O v` cnmm30 /) m
v'vv / J
't1 0
M j. XI '1 33 r
e -4 0
(0
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
kov
I. Blue File PERMIT NO . ?
2. Gold Airy PERMIT
� _ -7 .44 y--
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I "7 Q1 r � a Cfr
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) j (An t Oh1 (Phone) LCO S
(Address)
APPLICANT
(Name) (Phone)
Appliance Connections Inc.
(Address) 12859Clicstnut Blvd.
9e, MN 55379 (City) (Zip Code)
(Contact Person) 952 - 445 - 4803
(Phone)
APPLICANT SIGNATURE M DATE
,15 (3
I
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 I 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 Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, PLUMBING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ ' .S8'
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ _
This Application Becomes Your Building Permit When Approved Paid S Receipt No. , -
Date .b-72,66 By
Buildfne Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372