HomeMy WebLinkAboutWater Heater 13.1406 5 0 d 0 000000 = 0 w Nn
y 0 vi„ - -n„ - n 0 5 G v
0 0 0 3 p -H 00 Z m 73 m
0 b m y S Z > 0 y c
ak
-Ai > Z m - -1 Z- zx
C m - co L z
�
mm
t 0 \ Nzm,
`41% k \ 1
RI p ck 000000 1 ■
m 8 ° c
x, m , Ill
° o z \ k wcc Z r ' ' . \ - " - -., . : . \ ,,, t
C Z n m I v r 'o 1 P m NI A
tq C m
C O \ \
y . 000000 \
m
° < n Z 55 ;�
hi Z > IA m1
r
0 4 PRto Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
H
v 4e Vet
1. Blue File PERMIT NO. //
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 j)ze
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
r r JOIN' na (Name ) �/ r/� r� '!"�a � (Phone ) 5 -
(Address) �0/-----
APPLICANT
(Name) Applianc Connections Inc. (Phone)
42850 chestnut Blvd.
(Address) _ •, • • - - , MN 55379
(A .-, ,'tX (City) (Zip Code)
(Contact Perso • ,4 / li - ..1. / IN (Phone)
iar114/2
APPLICANT SIGNATURE 1.4 aa. I y� ! DATE
V APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher t 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
The Minnesota Statutes § 326B148 FEE SCHEDULE °SUR CHARGE" has been extended -job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The minimum surcharge for a
"fixed fee" permit is $5.00 $ Building Permit #
PLUMBING PERMIT FEE $ to 1)
STATE SURCHARGE $ .,;il
TOTAL PERMIT FEE $ r . 1lik
i Mr
(office Use only)
This Application Becomes Your Building Permit When Approved Paid j- 45 -6 Receipt No. 7 .
By
Baildine Official Date Date/2123//2
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
_
.anl anoif39nno3 93 ?unfaeri3 088s
evcae VIM .99w:
comb- BN-see