HomeMy WebLinkAboutPlumbing Permit 13. 073 Er 0 ❑ C) ❑ ❑ aa ❑a i 0 Dv 20
° 0 o 0) in z m mo
o r ° m , x m Z 5 —Z ° z mzd o 0 ori�
L21 r m m to Z 0 _100 Z70
-moi -°i > -i mz xi
b > N V1 Z z 0
C m ° LI '^ C
�°, c ° ° Z m m
'+ ° > o
q -+ -n to v N
m ,7 0 O . l
000000
Ox.{ Z O O nC ^� .enc
E -0 0 0 Cn c
9e _ to I O r�+ m 0 m 0 n
o n , - c>Q8°° m 3 = m
v. Cm) m 0 ' r ?1 O O -1 0
W
Z r
p
0
M
x 73
o VI 70
° X00 ❑ ❑ 0
va
� m 4..
Sy:Z_ 71 _3 0 0 ,Rz mmr. m
a 0 C � oC)c�m
q.a 0c) —
m
-4 r 0
0 PRIp� Q..)Date Rec'd
NCITY OF PRIOR LAKE PLUMBING PERMIT
v
Blu
Col Cit PERMIT NO.
2.Yell Airy % D 7,3
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS _ ZONING(office use)
l5 & ô Ok FiNdj& C S1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PH)
OWNER w , (,�n
(Name) 1 I / - t� .4 (Phone)61527- f if - qad3
(Address)
APPLICANT
(Name) Appliance Connections Inc. (Phone)
(Address) 12850 Chestnut Blvd.
(Address§hak0Pee, - 43379 (City) (Zip Code)
l 952..445 0'803
(Contact Person) ab. / /. . (Phone)
APPLICANT SIGNATURE / i r P DATE ,
?/ I3
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 Assrbly 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 5-0
"SURCHARGE"has been extended 'LUMBING PERMIT FEE $ 11 ,
until June 30,2013, ;TATE SURCHARGE $ w V S8'
The minimum surcharge for a COTAL PERMIT FEE $ ��
"fixed fee"permit is$5.00 `1�
lifts Application becomes x our rimming Permit When Approved Paid Receipt No.
Date �/ //3 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