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HomeMy WebLinkAboutPlumbing Permit 09. 0079 ) O J F- w v Z Q z F w J w z W ►- r wW - z ty Q O O- o �� Z 4 -r W ULilLC7 W • 0000❑❑!. -Nn3 ) re V =O uJ re X .i IL CV c) O z .J 1 j w O J z _ D Y z ° U V 4 w i a : F _ a O O --1 I F- N W o W IN) E' 2 0 O O U' Z W t � O y = z a ?_sxz_ a Z Q R 0 w m a aa[G LL O ra U a. D P I- n0 `, o o z _ x o J W a J v W W W W (,y a 2 cn a� 3 a 00000 0 O O O rt W ` r Z a r , O w o z —4444 o t�� W U O Y r` g o4 YQ V z ` < ►- W :? a J z 1- N Q ° a oz 0 0 0 1 a 4 �<, N w C4 N O z p? z W W a' 0 4 A LL • F - V) a z ~z2 D Q W O re 0 0 n U V O W C4 W Z ° 0aa NZF- 2 3 V U a a C 0 O O LLZ ti,vo Q o U? a 0 = a 00004 0 c PR / "" Date Rec'd \ 9 CITY OF PRIOR LAKE PLUMBING PERMIT 2, 2. U& rn • NESO I. Blue Flee PERMIT NO. /� 007 3 Yell Airy 3 U�, Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER -- ( r� (Name) _ CH Pf N n )' A. C/ B .2a ii- s is (Phone) 9 5 - 4 , 4 y v '7 / Z.6 C.ic -L ,,/7.— Zit 'Z, Z'-/a Z (Address) /c. '7 c I / v,!3 .s .. L a e c>014 C.. r . R21 .., C a i=-6 (Name ) A 1 ) A7 Vk' "/ / 3 / (Name) :e At," / � c- (Phone (Address) (4)0 ° 3 N �J c. �lfY1 t h , r.1 fir- -34-3-0,03 (Address) V (City) (Zip Code) (Contact Person)- (Ph / one) 6.'37- - jS` � 1 , DATE ,, - -2 S" © O APPLICANT SIGNATURE - . -Si AP • ICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins 1 Dishwasher j Water Heater Floor Drain / Water Softner 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) 4" Other I Z u ' ',4 I rt l ' G , a r►, ✓ i , ,.d. - p.-- is v /; i L L •�' 0.4-,y, A . co c , , Z , -r Or- 5 A / ; t of to FEE SCHEDULE ,i 1 A/„ r ai r / t, . `7o C v fl. ' Tes' Industrial, Commercial & Multi - family 1% of job cost with a $39.50 minimum Residential, New One & Two - Family $99.50 Residential, Additions & Alterations $39.50 Estimated Cost $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ (Office Use Only) 1 This Application Becomes Your Building Permit When Approved Paid t/ v Recei t o. s �� 8 � io Date Z U � By Building Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372 -1714 • • •