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Plumbing Permit 14. 1012
au Z 1 § 1 1- 2 Iii 0 § �� 4 2 � \ k k _ o & ww ■ 2 64 § 5 ��� § ■ 00000 § 2 o re x 2 N § o 0. a. w & z -J 2 m2� c 0 § ■ § QEr -I 0 0 0 K e « b la 2 g x z B _2 _ § §_zz _ 0 . a 0 a © fwW �� 2 3 2 ® § uI- § cc ■ O. 2 $ ■ a2 § § � wcz 4 000000 § x 0 % ■ ,- a. -1 0 i 0 UJ w .40re < a e © O o - © 0 8 50 z p � § % ■ zz 0 z u ■ < a OM z 2 o a < I- 4 % FE # g ZOE5 z " � � W � � % 0� 2 - LLI nz ■ 04W o « /% § § 0 U.U. U.§ ■ k 0 k S § a 0z 2 0 a 000000 U lk00 £ > . Date:Rec'd eitC)HVIL1041) CITY OF PRIOR LAKE PLUMBING PERMIT ty 1.slue File PERMIT Nat 2.GoW City1/` `e— i 3.Yellow Applicant / (Please type or print and sign at bottom) ADDRESS ZONING(office use) , sôJ4sa LEGAL DESCRIPTION(office use only) LOT f BLOCK ADDITION ��� �. ��'���� PID L15- Y6- L 35-O OW (NaameE 14.17-441,(4 541494rec, (Phone) (Address) vV ,/ APPLICANT (Name) (Phone) (Address) 12850 Chestnut Blvd. ikopee, MN 55379 ( X34 L45-4803 (City) (Zip Code) (Contact Person) A (Phone) '5. 0 a APPLICANT SIGNATURE I ' 1 a / _/ DATE / NMI APPLICANT 'LEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher i 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 The Minnesota Statutes§326B.148 Residential,Additions&Alterations $49.50 "SURCHARGE"has been extended st $ Building Permit# The minimum surcharge for a "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 7r T. cO Receipt No. a lirallgj By 7 Buiidins Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372