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HomeMy WebLinkAboutPlumbing Permit 14. 0911 z 1N Li O Z W V < 0 w it W :> WNDrtcd UJ LU4 z ;Z 0000 ❑ ii CZ lOLm W Z YYpZ � U V 4. C O.Z2O1 W W x 0 JW < JW Lu W pG a23Na2 0 0 Z () (1 000000 114 Oa' Ore a' _1 - 2i1i S Z N 0O o z0 w FN- < 3 a z Z W W J ao N o zoz~ z Wwe a o IL f' co U1 Z W 1- Z 4{1 I V CC CZ t C1 V �N pp = LL�� ZLLN Q c.L0 ❑ 0 5Z a O a 000000 0 RR1 v Date Rec'd ` o� CITY OF PRIOR LAKE PLUMBING PERMIT F 07 7. git v '�r so'se i.sine File PERMIT NO. � / q i/ 2.Gold City (( 3.Yellow Applicant it f (Please type or print and sign at bottom) ADDRESS ZONING(office use) 1 1/STS ?hsivrt ead© t3 A"( LEGAL DESCRIPTION(office use only) LOT 4 BLOCK 2--ADDITION /6,4 A?e c o 2 lv bJ/A4 /V PID c 5 4/7 17/s o 6 OWNER „Q (Name) a-'�10u -Ja S S (Phone •� ' , ,9 (Address) C JS oR 7 gi p,rW O Q Dl 'i. �(A - APPLICANT (Name) Appliance C3i-riectionS Int-, (Phone) (Address) 12850 Chcsinut Blvd. 5-4803 i (City) (Zip Code) , (Contact Person) `/4 Y Y)t I i (r (Ph one) APPLICANT SIGNATURE / J,(, DATE : . - 0 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 The Minnesota Statutes§326B.148 'o of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 "SURCHARGE”has been extended The minimum surcharge for a ,st $ Building Permit# "fixed fee"permit is$5.00 PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $/ . _ (Office Use Only) This Application Becomes Your Building Permit When Approved RS1-5k.,5° Receipt No. 1 s, / '� B I Buildine Official DateDAtz:6 !/� 1 y 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 U 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372