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Plumbing Permit 12. 1489
E 0 O 0 000000 U 0 > E n n $ nno . 2 ■Z$2P00 § 7 Q i q rn § R i E � � 2 q � § t \ m /o�@ P z- ■ • n & 2 § 73 2 -4 ; 0 / ® o n d c p n \ 0 > k ' m m 25 73 r r © % 63 ;g m 0 73 73 11111 kOO . 000000 § m q�� ®r ® *Er 2 -1 § o o ll oc > c,c zs ml■ To 0 2 ■ m �§■■■§ m 0 0 § m ƒ q > 0 X % 0_4 0 2 r -n ■ , 0 § ' m r -0-0 O . $ I! o • § m c m . )F0 00OO z � ��q K - zo m R. / �� / � c nO K x ' - ^ ■ E 2 § ... m 4 pRtp Date Rec'd H 7071 CITY OF PRIOR LAKE PLUMBING PERMIT v rs 1. Blue ie PERMIT NO. L � 2. Gold City /v 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS t " ZONING (office use) Ca /SO c� . LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID ((Na �) l� NY' `�` t ' / �°�-' (Phone) Jc/ (I/ L/ (Address) <C /ry €— g 7 ° — APPLICANT Champion Numbing (Name) PC 000308 (Phone) 651 - 365 -1340 (Address) 3670 Dodd Road (Address) Eagan, MN 55123 (City) (Zip Code) (Contact Person) -, �� .G Y'\ (Phone) ,� / a 1 . 0 – 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 Estimated Cost $ .C_ oa Building Permit # The Minnesota Statutes § 32611148 "SURCHARGE" has been extended PLUMBING PERMIT FEE $ until June 30, 2013, STATE SURCHARGE $ 50 The minimum surcharge for a TOTAL PERMIT FEE "fixed fee" permit is $5.00 1 ms Application necomes x our nutfding Permit When Approved Paid // Receipt No. / 7 n 2 Date /2 1 2 4 4 .2,, 4 .2,, By 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 t , _ , • t