HomeMy WebLinkAboutPlumbing Permit 13. 0559 J
co la Z 1 (j)
t.
p J - LL . cr w
^^ Z W
V I r f Z V a V ¢ [x,
In ° 5Z > lyv _ � a. a. 0. U o .41 1 02wwa,� ,% z ¢
ill
< \ W UIiLL Z H
p 3. w
❑ ❑ ❑0Q Ct
0 0
1 '\. w z
ce O N
W \ Z Y Y Z m U O 4
Z f
O Y Fes
C
1-• U O O U¢ k7 Old O_ U
F- w o
s N w Z Z. 2= Z Z w 0 O R
,_ O U w m = N z •
? wa _i ° w ww z x w
a 2 3 cna 2 U v c4 z
Ca ry
0 0 0 0 0 0 re ° a 0 z
0 ► a a LL ►-
re
cn 1 ` p Q V 0 .
g • W l^ 0 Q ° o
• U
~ to co Q
• Z O W Q I- F w a
EE Z z¢ z~ N 2 N w w W z
o w W m w ~Z4C n OC U V
>- w w Z p O � a'' L ;� 0 a
a 0 0 LL LLU., ? LL N 0
• to ❑ ❑ c
U? 4 0 x 000000 0
W Z _ z 0
J a'ti w
u Z U U a Z w k
N 4 a 3 a aaJ C7 0
W C\1 02 W w , i w , w Z K( Ni t \f\ ,(� O LL tZ C9 re ? i..., � v" 00000 0 (.-__ w cn
t'i" ; U O '`
Z
w z si
J Z Y Y CO o ' 0 W
7 F- 2 OO1y- c � � 0 U
_ • `- Z Z 0001 � " 0 c a L
O U O a iii m = W j 2I a • Z O 3
vi N
? W< W W Z X O
a vj a 2 C 0 0 a, fZ
a
❑ ❑ ❑❑0❑ J o Z O w ` C
p, a. 1+. H
0 er 4 0 Z J . 0 IQ
W w �l 1- Z , o w
4 G
g 0 u O � m j
0Z O Z W F- r_ a 3 i a
O Z p a R a 1- 1- 04
d° 6 z0Z Z W Y u w J A
w Z w Z oO z N zo- g cc O ct cc o
O
a 0 0 u. u. u. F. a u 3 0 , °' ,
6 ? Q 0 x 0 ❑0 ❑ ❑❑ O 0 ❑ Q1 c
YR Date Rec'd
°4 ' t CITY OF PRIOR LAKE PLUMBING PERMIT L
INNEsd . Blue Pile
G pi PERMIT NO. /j _DI
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1- 5q?)U ‘6 k- 1?— 0)1 -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N R 1.\ • V ..l - � L \Oi1.e 1)\ (Phone)(15 Li L- S T
(Address) " 1 L' cYA., 0 L1 ,,,, I-- r SC_, `2/ cY\ la ht n-i - 3-
APPLICIT t�� /� n (Name) > (./1, v 7.' \(1W -1 �1 � �Z— (Phone) o ' '---)
( Address) 5I l'10 �4e fauk &I i1,1. &Y1- L01 5
(A tress) J (City) (Zip Code)
(Contact Person) c 1_11 (Phone
APPLICANT SIGNATURE ` A-- DATE S I 91
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 1 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 $ Building Permit #
PLUMBING PERMIT FEE $ 4 qa-)
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 3H
(Office Use Only)
I
This Application Becomes Your Building Permit When Approved Paid 5 ,_ 6 — "z/ 31) Receipt No. ` /
Date l - B
Building Official Date b ...ALA-
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 I
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
1
ti