HomeMy WebLinkAboutPlumbing Permit 14. 0765 C) 000000 = o p No
5
0 ❑ q I
0 -n 2 m T1 "TI O 2 I 'O
°c °o m m mo„
�o
o y o p m 1 >0 z °z x
hs r cmi Ii y ZI m O 0 =00
b o n m 'o °x
co 7:1 z m m
cti
X/ r c 73-74
El
O 13 IP
000000 W
Z a m m "' c ym �
p xi z o v x3mmmxW m o y
f1
�' zcfi �11�► zzxpx� czi 3 X Cm
CC 13 M -I — r �Z00 A =I ".1
C
b n 0 cc 1 v
o zrn r (�
oo 0 q m
ii. °
0X 73
f
m y
c 0 0000❑
tti71 „ m n m en F
Ii
U\
le
-- §m
m � zcrc
ci
Date Rec'd
101
4p�O -7 3( / S -
CITY OF PRIOR LAKE PLUMBING PERMIT
' 120,..0
I.Blue File PERMIT NO. 6
•�1Y� 2.Gold City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
C—L3 O �'l pl'tf AAA-
eo se
LEGAL DESCRIPTION(office use only) �D ett 8O e 4-1/-
LOT
-1LOT BLOCK ADDITION PID
OWNER OVA
(Name) (1LC.Q kWh/WM (Phone)
(Address)
APPLICANT D ho--- ��i- 1r
(A-
(Name) ° (Phone)
a V2- 62�2 41. 4 //v /j'1 kt
(Address) (City) (Zip Code)
(Address) (City)
2 ff�d -eve,6' �-� �'oc (Phone) 1/
(Contact Person) � z,44_.
DATE �"31
APPLICANT SIGNATURE
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
Industrial,Commercial&Multi family 1%of job cost with a$49.50 minimum Residential,New Residential,Additions s&Alterations Two-Family $49.50
Estimated Cost $ Building Permit#
the Minnesota statutes s 36613.1415
PLUMBING PERMIT FEE $ "SURCHARGE"has been extended
STATE SURCHARGE $ . v The minimum surcharge for a
TOTAL PERMIT FEE $
31 "fixed fee"permit is$5.00
(Office Use Only) "
This Application Becomes Your Building Permit When Approved Paid',l u� "..0tit IVO.1 i 0
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