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HomeMy WebLinkAboutWater Softner 13.1353 I OO 0 000000 - 0 0 » 20 2 n n 0 ■m E �'i'i 0§ 0 � � k r 7, 73 � 3 dFc§z m■ 1 0 § t 2 k z§ E § � 0 P o � xp k ■ - Ch �m . - Z . 0 o . 0 © ` � k § 11 n > 0 �_ m % r § 7 m -o z k ° ow 000000 o \ mPA D IIP• cv®$E-0 P or c c % \ B U 0 . � � . x oo m 0 � �o § m 0 0 rm88 2 q 0 § o @ ■ z z . F o z n m �, r m m P m . / 0 z \ A 8 0 m DooQOo t 2 2 . § i Vin t- R 0 `� 0)2ME In 41 41 z gss ; g q m ■m� k A 0 - ... • .... .• 4 P RIp Date Rec'd H CITY OF PRIOR LAKE PLUMBING PERMIT - . .► sots 1- Blue Fik _�v1Y 2 00ld F ,�, PERMIT NO. /3 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) ILL- /5 Bre.rilvood l Prior � LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID (Name) OWNER ��f ,-• _ GI (Phone) (Address) I L 1p I $ is r-erI l )LSD al 1 GL-6s S APPLIC I / (Name) -/C�( w t/ �/"'� t'1 ( Phone ) QSZ - S 3 ( )IA '3 (Address) 04 6 0 I I d_r. -ad 1-4.1 _5,50( 11 I (Address) I (City) (Zip Code) (Contact Person) \J # 'J te (Phone) q ' APPLICANT SIGNATURE DATE 103/411.1 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 FE EDULE The Minnesota Sta tatutes § 326$.1448 Joli cost with a $ minimum Residential, New One & Two- Family $149.50 "SURCHARGE" has been extended y Residential, Additions & Alterations $49.50 • The minimum surcharge for a . • "fixed fee' permit is $5.00 $ Building Permit # PLUMBING PERMIT FEE $ 7`y ` sue STATE SURCHARGE $ XXX 5.00 TOTAL PERMIT FEE $ , SO (Office Use Only) This Application Becomes Your Building Permit When Approved Paid j—, / 37 Receipt No. 71 yp Date /2//D a By / i Butldine Official Date iv 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372