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HomeMy WebLinkAboutPlumbing Permit 14. 0811 ,QQ� r.. W 41 au- oc ign; f" WW: r ifs ; 10 ,..- \60 L1ItL LL 0 tu et 1T 0 m c Q W !J Z l Q. c'', ft' a O. P ti IL/ a J Z o o w N $ 3 W - 0 Lu Z _ Z = 2LL G C Z 8 rt X w S 0 W m � � � f� = W W W W 0 �� 0 d ?W< ?W i O 0 W ai3v� a2 avi a IL D❑❑DOD C. re 0 ~ Z U N IX ZOO 0 W h" asz �' 9N Z NYV W W • -n .- g J C cg ° u 0 - are oG Z 0 pril lii . � re < Q L0LL � H0 a ❑ — vZ 0 D • a 4 PR IJ • Date Rec'd ,� CITY OF PRIOR LAKE PLUMBING PERMIT . ti(rs :074 PERMIT NO. /4/.c 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(otr use) 5C7 1+ S6woo,i C i 1 LEGAL DESCRIPTION(office use only) ?� LOT ( BLOCK 3 ADDITION ��l J l241//146 PID R5-- OWNER (Name)_ e me NC u S+c)kr (Phone) `75-oZ - oZvZ6-SAO 9- (Address) 3,6-I 6q,SS 0.3 00 at. C'. APPLICANT N (Name) IMSo�I.tGI 1H� P 1 t4 i V3 (Phone) RJr oZ-g7 S- '/" 3 L = 3 (Address) O�a.s Ltd k�� k V a 01 8 I O4e© l v (Address) r (City) (Zip Code) (Contact Person) y`f . L i Y\.01 �/m (Phone) 5 yyke_ APPLICANT SIGNATURE \1\ 1 DATE /i*- APPLIC'ANT 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 The Minnesota Stattttes§326B.14$ job cost with a$49.50 minimum Residential,New Ono&Two-Family $149.50 "SURCHARGE"has been extended - Residential,Additions&Alterations $49.50 • The minimum surcharge for a "fixed fee"permit is$5.00 S Building Permit# •PLUMBING PERMIT FEE $ i Co STATE SURCHARGE $ XXX 5.00 TOTAL PERMIT FEE $ tet-'q-' -O (Office Use Only) This Application Becomes Your Building Permit When Approved \ ( q% Receipt No. 1 0 4D t ate By Building Official Date til y J f(f- 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.S.,Prior Lake,Minnesota 55372•