HomeMy WebLinkAboutPlumbing Permit 14. 0367 0 J
w Z _ 1L
J o' ti r W
GZV V 4.1
W z ,L
02WWN 0 < W
W ( Z
< `" Utiti0 \y Z
o M M W m
N � ❑ ❑ ❑❑ ❑ o
V 0 .44
'Z'" W =
U.O N SiO
W L 0 oC
O Z a. a.
Z 0 I 4
O F' E 0pu, J O ` 0
O , I-es2 0 00 0 < V d ILI a a P.
Z Z Er za_ = SZY. W N
• m CLx LuZm a z
N 0 a _jwa _jw u) ItG
W W W X az,
A a23a) a2 W W W
000000 ce m• ° 0 i i
G. d LL �.
0
�■. o < V O W
Y V z • 0 0 Y` too e<
0 • z 0 Na���n OI
oz 0 0 w H / 1 1 -►g w
z Po - a z V 0 0 J AC
Q.
N Z zo ? g JZ W Y au oC o a q
u.0uj W "" W 00nirM < W V V
Oa 0 00 ou.oUZLTy 0 • v v b
.55z 0 0 a 000000 0 ❑ ❑
04 PRION --Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT /
I Blas Fila
2 cola PERMIT NO.
. City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1S6 3( srt l/v z , .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT nn_
(Name) !SO�— V�ct pid.+,ec,i (Phone) 6l Z Z-76— g ? Z
(Address) PO 2 /- /Z S� _J Ip!/'v( Les k 7 Z
(Address) (City) (Zip Code)
(Contact Person) �pt_ (Phone)
APPLICANT SIGNATURE DATE S"--/"5"--161(
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
t 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
The Minnesota Statutes§326B.148 Residential,Additions&Alterations $49.50
"SURCHARGE"has been extended est $ Building Permit#
The minimum surcharge for a
"fixed fee" permit is$5.00 PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
- - - - - TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid �— Re4e' t
�-C
Building Official DateDatg� L 1
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372