HomeMy WebLinkAboutPlumbing Permit 15. 0727 E 00 n 000000 13 0 > zo
n n 0 e11s "TI 'II 0 § o 79 4
§ r 2 2 2 3 m §cEE _§ m m 02
\ § Z tn k -4 PN Ca 0�
§ § § Cn 0 2Z
§
d
7 2n
o �
\ o a > o m
■ r § 7
oQ
Z k O
O
000000
Z 2 m
x m m
41 m � �
\ 3
OS .4XI 0S
n ■
. E m › 090 0 3 k |
tviq U 0 " §o o
,_ . z
� m
m r *a �
�
z m /�
k \ 0
ti m OooOQ
PI
zo � � n
§ ® Omm2§ -
E-u - -0 °
z m5 5 5o
§ t � ! r
� t §
� r o
`-� t Date Rec'd
E°0113111) CITY OF PRIOR LAKE PLUMBING PERMIT q <r
'fNNESD� I.Blue File
2.Gold CityPERMIT NO tt�++JJJ
• /� /��
3.Yellow Applicant f /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3 'r Stevt S dr Si.i
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT
(Name) (Oe_n/atA... Q(u Nt 61,..v\ (Phone) / L - 2.70 tS X 7
(Address) Pb 6a/... ( 2 -� L. .5-s-3-7
s
(Address) (City) (Zip Code)
(Contact Person) - (Phone)
APPLICANT SIGNATURE "Z - DATE 4 /2 t (/
/s
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher A 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
The Minnesota Statutes§326B.148 Building Permit#
"SURCHARGE"has been extended LUMBING PERMIT FEE $ 1t4f,rt)
The minimum surcharge for a CATE SURCHARGE $
"fixed fee"permit is$5.00 OTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid —�/�jj ipt No. qr./
Building Official Date Dat •
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372