HomeMy WebLinkAboutPlumbing Permit 14. 0789 05 0
/ � . C) 000000 .7 o � n
n n g o o 0 ■ "I - -n �� $ ®q
fn R 2 2 k Z kakc§ m m m mo
% t -I -I > K �kkkz o 0 51
cn �� .
2 Z Q o
B 0 _o m o n o z 0 ..
\ @ 7 6 K •.. -1 z o ■
o a i 0k
§ r 0 k m
a 7 2 IP
i
\ z q § . � 0�� 0QO `
* 3 0 o mr * sem
2 nc2m0c
4 2 cn 7 q 1111 $$■ §3$ m 0 « co `
0 k \ 0 r\¢0 2) k M 0 0 - ..
0 ( ,- r 0 ( . W
/ ■ 0
m
8 0 .
®
/ .
Z ',..1
ooOQ � �
� % B �XI; �§ §2 ��. �� � y
c §m § ® -
M 0 � � m;;�§
m . Ism2 ■ m
co E c
� r o
G
� viag+ Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT r..5
4eNvEsoo
1.Blue
2.Goldd City PERMIT NO. X4-. 7�
f3.Yellow Applicant
t and sign at bottom)
�, (1DDRESS� ZONING(office use)
bc. ' AW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) r�'+-J Q d- (Phone) Ui�2- — 2 2-3-)?6,
(Address)
AP T / p1/
ame ����Z hon 60/2 P"?A� DSO r 9�
,timrim• 57v2- av,(2-pyrk-tiiv. 64/41
(Address)
' (City) (Zip Code)
entact Perso (ICj A5 ( (Phone)
• • NA , /
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
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 $ Building Permit# The Minnesota Statutes§326B.148
PLUMBING PERMIT FEE $ � "SURCHARGE"has been extended
STATE SURCHARGE $ The minimum surcharge for a
TOTAL PERMIT FEE $ --5Y'S O "fixed fee"permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid S z) / 0. 7(7t NDate S
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