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HomeMy WebLinkAboutPlumbing Permit 12. 0816 N ❑ 0 N4 0 00000 0 = 0 > in 0 0 N, O tn� 0 v SO n 0 a 0 0 0 ". mzu z m m m0 b r > - ° 0 0 X m m r > - C 3zz x y � r m m N fn � gv z Oz u o 70 -4 > Z v -4O -4O Z- t o f > i I ao , �� z m m O D O m cli xi r v 1 A -1 m v v `I t / Z O O li 11' 00000 0 . '?f x m m m 0 ti� 3 ru' s c r m - • -4 Z v v 11 I 1 O - :Mr- r x 3 m x c m 0 0 O t m /1 i' I J m 0 Q 0 v o U I > -i O ( � rmOO 77 q p i v O 0 v �I D Z r • z m 1. r 'D m P 0 v • z r ` ` ! O m ( , , O- m ❑ ❑ ❑ ❑ ❑ z o „ � , c � m 0 ,2- m c � ic 5 i � �1 NI o r` , D_ -a — m m -4 r 0 1 — 0 0 0 0 000GOO "0 0 > zo cn § 0 r 000 _ j kk�o� § § k M 0 % r § ) m �2. ^� m 2� % § §} k }� % t ® ® q ' z c G) � � w » —I m 0 0 y 0 ? k § q / 0 ,_ \ m 0 • X r 0- t . -4 m 0 k k / 2 71 nn i ∎� 000000 q §) L ■� ®* ■� E K ° ° 0 -1§ ) 3 K/ m ! / m 1U ! m 0 0 0 la 2 § $ o › § 2-I f m ' 0 U Z r te)) - r c / } § / / ii P 0 X m . § 0 if � ^ m I, 01 13,00000 ® / > k : � k Mm30 m 2 \E 'V 'V �xi , KC C ƒ q � % o PI \ m F ' 5 ■ � F - lk §/ 0 I/ C) Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT :...,,,,,:f t77 INN ESD' ¢ 1. Blue File �� -��/ 2 cola city PERMIT NO . /'� . 3. Yellow Applicant If/ (Please type or print and sign at bottom) ADDRESS ZONING (office use) 11- 1 CQ k Rosv\Jood kd LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER . (Name) kr'CS-f-A'‘ir\ K - C (Phone) Z- -� S Z (Address) 141 (O A Ro r- -v\i 0 d c i `i (Name � co \ S © !\ 21- (� (Y�1Z `� V v"l b c � hone) (Q I )---2-6 s 0 C) (Address) 1 J / ( \ T - or \ tut t ( k --1''\ oL` f TO h S S Z 5 7 (Address) l • (City) (Zip Code) (Contact Person) P i (Phone) I Z --7 q 1 4 C) 0 Z APPLICANT SIGNATURE . a , fl DATE - 7/1 Y / I APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough -ins Dishwasher f 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 § 326B.148 Est $ Building Permit # "SURCHARGE" has been extended until June 30, 2013, PLUMBING PERMIT FEE $ The minimum surcharge for a STATE SURCHARGE $ .50 "fixed fee" permit is $5.00 TOTAL PERMIT FEE $ .I\ s 5 This Application Becomes Your Building Permit When Approved Paid 3-) Receipt No. 4 `, / Building Official Date Date V .2. 4 .,2_ � By � 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372