HomeMy WebLinkAboutPlumbing 14.0072 g 0 0 000000 1 0 > 2
® nn 0 ■1s -� 0 $ 0 ��
/ r n 0 k 3 — rr �@
M r m m co m§ > — ■ �13
10 % ^> - -1 m � � � 0 ��
% 7 z 0 z q
% 0 0 z 0
r
11 '0
f k §§ 000000 .�
O \ m m qr® >rn§ ■
�n
/ \ E \ > 0 0 0 � 0 0
(e m
n 0 o r � § o ■ ■ 0 c
0 § Icy z r a co Z F m r vm 2 0
2 ig 0
z
( --i
■ m
• c §
?D' _ m ����� 1 N
z __ §
ID
R. v 0 CmrM
% z m \_ 0
M n amml
M 7J -n 73 r. 2
M z m
/ _ 0
,
O� PR ip� Date Rec'd
N
CITY OF PRIOR LAKE PLUMBING PERMIT
�r so ar
Blue F PERMIT NO / 1� -
z. cola c ity •! 1 1
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/437? 'Rohm' Rd Iv
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER •
( N a m e ) & & ed "Re. 1 (Phone) 46 — d 33
(Address)
APPLICANT
(Name) AppIianne Connections Inc. (Phone)
12850 Chestnut Blvd.
(Address) S ko ce, MN 55379
(A� 445 -4803 (City) (Zip Code)
(Contact Person) 11 (Phone)
APPLICANT SIGNATURE , leis '1 °L � °� DATE / / —
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
The Minnesota Statutes § 326B.148 FEE SCHEDULE
"SURCHARGE" has been extended If 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 $ q• 50
STATE SURCHARGE $ ICY
TOTAL PERMIT FEE $ 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt
Date By
Building Official Date -
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
r ...