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HomeMy WebLinkAboutPlumbing Permit 14. 0516 5 i 00 0 c) mz- 222 o 0 > $ n A n g © © o z o $ v -< k r kkm s mrr3Zk Al vi §° / % )14.78 § m %o » B P C 0xp q ■ ] Ch � © Z 2 z 2 \ 0 7 0 0 § $5. o a » 2 .4 z c ICI A r § 7 1 1 4.. Z k 0 011 O/10000 Z . M m 2 mrCh * ■ r C3 - § m § > m x & mx & $ 2 ' ƒ 0 � 1 ■ ■ _■ � m o o % 0 R 2 / , > .r- ZZ o § m § z , r o 73 q o \ � kk o m S o § % / c o 2 m 000000 rn . o R• » xi K C"mm ,m 2 ■mm ■ o m » c -0 -0 -0x q 0 f §&ti . 71 ■ � r - init § m -1r | | 0� p�0� Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT 8 1 6 ,04 4eNvEsoo I.Blue City 2 Gold CiPERMIT NO.A./, 5/4 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) 379/ Tum a\. P40 LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PH) c9S7 qiii 2 • W I.O OWNER /J c- _/, a �%�� (Name) v ` (Phone) (Address) 9 / %`t'NktA 0,1 , APPLICANT }} /� ��"" �n � d �j, (Name) i 5 D 41 61 J# (Phone) 612'"t'( Q ' fr (Address) ( 7� a„..if -44 104/44673,t_. c3T 2/ (Address) (City) f (Zip Code) (Contact Person) /4 -B��i f/ - (Phone) G/. —<P6 e fr Vf' APPLICANT SIGNATURE Q`.-16-"t- DATE ('—/2 -/ 7 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 rWater Softener Lavatory(Bathroom Sink) C 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 Estimated Cost $ ?C)0 Building Permit# The Minnesota statutes g.32b1114ti "SURCHARGE"has been extended PLUMBING PERMIT FEE $ 41' The minimum surcharge for a STATE SURCHARGE $ 5"-;°IP "fixed fee"permit is$5.00 TOTAL PERMIT FEE $ ,0/.517 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid szti S Receipt No. 17/s-11 Building Official Date Date `^• ,/( By V' 24 flour notice for all inspections(952)447-9850,fax(952)447-4245( 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372