HomeMy WebLinkAboutPlumbing Permit 15-0069 I 00 0 n 000000 0 > 2A
n n \ 00 0 . � m§m °° Z m 0 � 0
eco m m n0
C)
riii k0 r) g $mak§§ z z § d-0
hi4. -, § �j � ■ o �
w a 0 zz§
q
S 2 z � ' \ z mm
hi 2 r 0 <
r 0 (
0
Z sZt
k0 0000000 O
41 m q m m V � MMW * EM X
\ �-1 z � § k ■ � � � m p n
X ) X
E - c 7_40 r no 0 m % p 0
§ 0 a a § MX z r
z § m rm -o p m
o � � �
z m
E0
■ 2 1.-----)
000cc
E A - - §
R• » 0 ■ m� 8o (
k ��� E
4 § ~ ? mm % _
§ m 22� z §
-4r 0
Fl r5—t01 1.9. . . -
•
OQ r�0�� Date Recd
lY I CITY OF PRIOR LAKE PLUMBING PERMIT •.
v
41.,.Sys rFite
;:11,1, clty PERMIT NO15-
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS — ZONING(office ase)
C1 1 ix Tri L. N uo
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Na�am)R J ‘. OtAt.(cr ,
(Phone) lSZ" L f L/cC—550
(Address) 29 l �-O.� Trak ( l
APPLICANT / 9s2.-7(..07- r�
(Name) A Z & A (Phone) (0 0 0 —
(Address) 2 2C0 0 W w,. I •!♦ A V ( k 3533 _
(Address) (City) { (Zip� Code)
(Contact Person) A (Phone) 1 5 2 7 , I - -V
•
APPLICANT SIGNATURE •f bir, 4,...._ DATE 5 L ___,
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher l ' J Water Heater
Floor Drain Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(I or 2 compartment sink Sewage Ejector
Shower Stall - Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
The Minnesota Statutes§32614.1'48 job cost with a$49. 50 minimumE �E Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended' . . Residential,Additions&Alterations $49.50
• The minimum surcharge for a • ' .
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $ LI 9 •S C)
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ 3L/ .5O
(Office Use Only) •
This Application Becomes Your Building Permit When Approved Paid5y s7) Rem' t No.500
DateBy a
Building Official Date 4 -1.-1 . (C-
fj
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372