HomeMy WebLinkAboutUntitledBuilding Permit 13. 0870 J
N
F CA. a EC c c ui E
SU !`-0 0 w
2 555=
aaa3
co W W 03
U 0 "11 �Z _ Z
o 8��� z
I ❑O❑❑ ❑O u, a
o
W = u.
Ce W , , z D. ■ 1 u. o w
O oc p O0i..., p U o °'
• , \ W z v c a a
4 W 8 o V (n 0 a co u• N z
0
a..'Ms W W W W Li '
❑ ❑O ❑D❑ �
to
ct z p� W
0. 0 -j
O Z ` ti 0
XU Z 4 1 p
5 0 0 u r' \ w a
Zx ti 0 w N z N v
a s rn z Z g? 5 x W X i s a u \- q
� { W W Z 0� C 2 0 o o f U V
el 0 s 0 U.U O 3 U U a
UZ d 0 a 000000 0 A ❑ 0
PRIp Date Reed
CITY OF PRIOR LAKE PLUMBING PERMIT
rArEso * 1. Blue Fate r
2 . :14 y PERMIT NO. /3 _�f 7
3. Yellow Agrlicem
PPiease type or print and sign at bottom)
ADDRESS ZONING (office use)
1 7' +76 ee < e(c/ art Ve SI E-#
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
ame Y\ t ' t (Phone) c 15 , 9-- y LF 7 1 1-7,9 7 /
APPLICANT
(Name) M S C X kkOJ 1y (Phone)
�3 Ce r� Q 1 e_A\ke o MN
5S 3
(Address) (Address) (City) (Zip Code)
(Contact Person) 1-if L kv I fl" (Phone) ��f Me-
APPLICANT SIGNATURE • L dJ Z J V DATE 7
APPLICAN 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 § 32613.148 • — 1st $ ' 9:71 7 Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 5
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ 5;n4f)
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 5 '+, �U
is 55, beginning July 1, 2070
This Application Becomes Your Building Permit When Approved Paid 6 j"� j , Receipt No., 9 d/
�J`T d..
Buildine Official Date Date (/J J By
24 hour notice for all inspections (952) 447 -9854, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372