HomeMy WebLinkAboutPlumbing Permit 14. 0074 W z I VV W
i J E' a: P; Z
J �L
F 0 V tu u, V W 7
g 555V 0 •a
aa a�
▪ .4.- V' 2 W z Z [.
00000X 1 w ck
+P , 0 v
u. 0 N
W `, 6 aaQ z U O w
Q 0 N a j ti
_ z z � x =z � oW- 0 ? co
N 0 d jVFW- _1U W WW W I.-
L
O.wa JW � la Z �C IX ag3v�a
n 0000❑❑ 0
a. 0 a. LL c
' rc a a 0 0 14 J
W W z a 0 ix a
0 I .�
W a p 0 F N v
FE N O z z W 0) 0 0 ° a CZ
z 5 ac -I v VD U. 0 1- W a ' W HO W z 0
5z a O a 0 000❑❑ 0
t~ Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
0PRio,„
N I Gol d F i t l t y / q_1 PERMIT NO. 7Z.
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
15aa1) •ak,r;c 2 C\rc,Lx. 55 3 7 -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) t" , \ P
L 0 `-* (Phone) 9'S Q - 5 5 b - s a
(Address)
APPLICANT
(Name) CULLIGAN WATER CONDITIONING (Phone)
6 030 CULLIGAN WAY
(Address) NI ETONKA, MN 55345 (City) (Zip Code)
A dr y2) 933 -7200
(Contact Person) (Phone)
Mt APPLICANT SIGNATURE k DATE 1 -a3- i
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 1 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
The Minnesota Statutes § 326B.148 if job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
"SURCHARGE" has been extended Residential, Additions & Alterations $49.50
The minimum surcharge for a
$ Building Permit #
"fixed fee" permit is $5.00
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 5 y - S 6
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 'J /---; j (; Receipt No. � v ,, , ,
/
Date , j j / / By / /
Building Official Date � -/ 7 / T f -'' t�
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 f
4646 Dakota Street S.E., Prior Lake, Minnesota 55372