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HomeMy WebLinkAboutPlumbing Permit 14. 0737 Q0'4.. 8 000000 8 S FI I 1 1 .. 0000©0 rr.6_t a i a , _ II ' l' t 3▪ r P ,i'l I e r I'900000 —_'' a▪s r 1-4 C____-- C cy t PRI© Date Rec'd !as 0 CITY OF PRIOR LAKE PLUMBING PERMIT -. -7. .7_ (./, I Li. . cit• I.Woe Fik J.Gout city PERMIT NO. 737 (Please type or print and sign at bottom) 3.Yellow apyi.we — — ADDRESS i ZONING(office use) i L/e:;?3 j SA a re..c re f i"" s4-I Ves LEGAL DESCRIPTION(office use only) LOT ( BLOCK / ADDITION J elL- �c5 Tic/ Se-vein/A,.-.A, �� IPIA ,moi -6-n/- 0010 OWNER / )1/at /IC-(Name) d-/ '7l C� (/t C'-d (Phone) 95:2-:2- 30- olit 7 (Address) d'1.73/ ___-._...shen Cyt ✓J > l APPLICANT ---- c, (Name) f2C�1 kfro-y tilpO 1.,� t . ( ' (Phone) <7. U- Si ;- 9 17 (Address) 3.2J— G912 Mv') -Fi,�?S V J J 4� 'Ale--Y1 ,3,Y ' U (Address) - (City) (Zip Code) (Contact Person) _ J Of-) NPI il j&-,t (Phone) 3-2P" J' - ..? l J APPLICANT SIGNATURE ___9,_z61/._.___42 --- _.. DATE 9 -)/ APPLICANT PLEASE COMPLETE BELOW Quantiq Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain tWater Softener Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) Laundry Tray(I or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembles Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet(Toilet) Other 'Phe FEE SCHEDULE Minnesota Statutes §3268.14$ j job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 "STUnht.HARGE has been cxtcndeti Residential,Additions&Alterations $49.50 e mujj ttitrr surcharge fora "fixed fee"permit is$5.00 5 _ Building Permit# _.. - PLUMBING PERMIT FEE $ Y9•41 STATE SURCHARGE $ AU 5.00 TOTAL PERMIT FEE $ Si. (Office Use Only) - This Application Becomes Your Building Permit When Approved r'l -• Receipt No. f Vi _6) `' 1 • . __ B e / By AP Bulidlae Official Date - " r • 24 hour notice for all inspections(952)447-9850,fax(95 )447-4245 ��._r_ 1 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372