HomeMy WebLinkAboutPlumbing Permit 14. 1167 5 0 0 n 000000 W 0 > E
n n0 ■I
0 o 50)
n n a o °73 m o 2 § m z -
? & 0 § - . . - 0
§ ■ 7 0p o ��
n m f
% 2 F 2 f f m
§ -n
, 2 0 73 X `
% m ° R , 000000 �.
Z � m m
' ■ � ■
kk OE nc
§ k Ca E �
■
�\ zk� �m ■k■ n k§ § k
rn q Fl c`a vl r
z $ § -0P
\m m\ r. 0
0 m
§ n0
� co ❑ OQ
E r %o§ 0 � � §§h o $ o _
R.
III Al
ri t;
o A k §x a -
7 rn § r§ ■
•-t r. o
C/
O� p�O� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
KCDf 0, / 7. /
......._.„11'4 1 4v,„Ese
I. Blue FCit e PERMIT NO. 11 ' --
2.Gold City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(Mice use)
I� 31/ I1 -i1?- Sb 7 ' is.6
LEGALDESCRIPTION(office use only) �,,
LOT `�LOCK /ADDITIONa1 2 A1
1 , /4-04/A) PID R5-- `37.12/O—O
OWNER
(Name) 1. e f n�,►,,1'0010" 31 y�/ (Phone) qs-a-Amice-ce3.3
(Address) Q
APPLICANT
(Name) (Phone)
Appliance Connections Inc.
(Address) 12850 Chestnut Blvd.
( , MN 55679 (City) (Zip Code)
;}. -445-4: 13
(Contact Perso, . II . , �/ (Phone)
APPLICANT SIGNATURE I. \ _._ r`` DATE 10 1 L ?alsi
I
/ APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher l 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
Residential,Additions&Alterations $49.50
Rctimatt:d Cost $ Building Permit#
The Minnesota Statutes§326B.148 'LUMBING PERMIT FEE $ ,��
"SURCHARGE"has been extended ;TATE SURCHARGE $ —
The minimum surcharge for a COTAL PERMIT FEE $ ,
_
"fixed fee"permit is$5.00 ir
This Application Becomes Your Building Permit When Approved alt:id SU Receipt No.1 /�1
Date l� By f/
Building Official Date i
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372