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HomeMy WebLinkAboutPlumbing Permit 15. 0544 LIS Z I � § ■ u § • z0au —o < 0 w 25 § § z a % is r aaa � _� j 02wwv) 0 0 « sv 2 0 wuu. u. o § ■ 00000V 11, 2 V) w o m rtx 0 § O z _ § § < co k 0 § M E re § § i - z 0 B o z ce § _ 29 § , 17: a § g o 0 a mfwCZin16 a J 2 E § \ jwa § ja I 00z I- o a ■ ■ ■ a ■ w w § w ® O 00000 § § § z % a a I- � 0 § o 0 \ 5 o H u. k u. k g Is 1 k ■ 2 o z Q ■ a ee z © a < 1- 1- 4 % 0Lu CO ■ 0M4M < la LLI UJ Ul -1` § /K § § Ili 0§ § �§Ik o%S § t a < 0 a 000000 C.) 0 £ Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT 1. Blue rile Gold Gotd City I PERMIT NO1'�- (Please3. Yellow Applicant type or print and sign at bottom) ADDRESS 3f. � ZOVG(oice use)C�© ��n Jz LEGAL DESCRIPTIO (oce use only) LOT BLOC DTT PID o'?":` ig 7-4032- OWNE IA (Name) (.."1/1...5(c/:E7\1:: (c I to I a✓Vl r 17).0 fkg n (Phone) `"Sa ‘"i7X.P/" (Address) Appliance Connections Inc. APPLICANT 14850 Chestnut Blvd. (Name) Shakopee, MN 55379 (Phone) 952-445-4803 (Address) (Address) (City) (Zip Code) (Contact Perso .ala (Phone) APPLICANT SIGNATURE /11 / (' DATE I 12 fr.'s"- 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 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 Estimated Cost $ Building Permit# PLUMBING PERMIT FEE $ ,4 STATE SURCHARGE $ TOTAL PERMIT FEE $ 4111 (Office Use Only) This Application Becomes Your Building Permit When Approved ' so Receipt No. wiff4 i ' ate Building Official Date 5‘�/� By c 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372