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HomeMy WebLinkAboutPlumbing Permit 14. 0981 J W F- 2 � N u. ce Iii wWW < U W U Ogw W Z Q w 1 -***-....--.}''. 0 re LLO N C: Ocoj W % O = M < m c O et P 141 0 4 C2 C re o $ LLQ o 0 w a S Z Z S S 2 W N O en U d mS W � mS vi ra 41 U "�_, O = V U O 20 ( ` l 0 0 Y S�� u of I d1 Z 2p ? g =_ W W W J LLU W d' W ~pm � md W w ct cc O Q O OW re W Z OOwNZ 2 O O O z U V Si c O u_ u. u. 3ii: in 0 3 U U as ES < a 000000 0 '/❑ 0 c 4 P P 1 ' 04 pRt04 Date Rec'd a, CITY OF PRIOR LAKE PLUMBING PERMIT v Boit, 1. Blue File PERMIT NO. 3.Yell App � . (Please type orprint and 3.Yellow Applicant 11 sign at bottom) ADDRESS ; / ZONING(office use) 5-e e(5 ?o\S IV W P 1 LEGAL DESCRIPTIONt� (office use only) s LOT (BLOCK / ADDITION . -e 9,4 C/' E '''C---- PID qtfp'3d‘"97 0 OWNER (�j (Name) 1.)c7, `12^(1r- O\f (Phone) g- 4 b I 0-7 0 (Address) \ G Q.,/ (P p.- '.,- S ?c,,s5 N `i V APPLICANT /11 1,..;\ p �^ II _ (Name) l...rf1�Wl 1 c7'vl 1I U YAIJ 1V\3 (Phone) Co 5) ;LO l LF 0 A 7 0 0 Q3 (Address) �� .. ....07 (7.,(-\ ��1 al (Address) (City) (Zip Code) (Contact Person) © .►• (Pho e) c) � 3( (3 4 ��, , _/ qQ� � � APPLICANT SIGNATURE — DATE APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower ou h-ins Dishwasher C\ Water Heater Floor Drain 'Nater S-oftener 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 ;t $ Building Permit# The Minnesota Statutes§326B.148 "SURCHARGE"has been extended PLUMBING PERMIT FEE $ IA 9 .50 The minimum surcharge for a STATE SURCHARGE $ .50 "fixed fee"permit is $5.00 TOTAL PERMIT FEE $ ,C,4 i go This Application Becomes Your Building Permit When Approved 0 4sI 5 4 .S- Receipt No f7 ate j / By Building Official Date l t(.( 5 eo 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 n 0