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HomeMy WebLinkAboutPlumbing Permit 15. 0729 L/ ❑ ❑� C7 000000 = 0 C vr HA n A a 0 0 00 3 mz �mOO z m 73 m O o 3 3z � m m AO * r -Ai -Ai > z y : A ' 0 •O Cl) za v O zo P 0 g z n � z mm hi 0 r z -I r v _ ,1 9 m4. °z 0 0 000000 m m m m ` 3-dr Ili Cy * 3c o 0, SG z v v �1 i3r�r mi3 A _ ai '.1 CA m ._^ G° MZz — m 0 A C m o r y0p00 0 E -zi r m ..e n 0 ,• r �1 O O 73 =1 FI 0 rTI =I b o Z ZXz k. F- 2 z m it o v A 730 2 n p/1 k< ❑ �lry❑ ❑ ❑ ❑ ❑ J y Z 22 (3 D "1in0 J G O 0 rmm3v0 m 1 n X ). mm4 � — v _. _ r m - N1 Yr 0 • C4 rRip� C/ Date Reed 1.1 CITY OF PRIOR LAKE PLUMBING PERMIT -• _Z.9,/s— U +4WW1` - - ' . - i PERMIT NO./5 t i-fa g 3.(Please type or print and sign at bottom) Yellow ADDRESS ZONING(office use) /63 sr, ' v -CE R25 LEGAL DES RIPTION office use only) CK LOT B © orf` a PIDa57-' 2 —fid/--' OWNER - (Name) s • (Phone) 75' 855 -943 (Address) /(Q 31-1 7 rK h vc ., V.Z-116 awn, Wakr (frhOf)ur)q) lie• (Phone) 306- 5R 0- a956 (Address)?0X (Address) (City) (Zip Code) (Contact Person) ..1 Dr) (Phone) 320 _ 5g 7- 0950 APPLICANT SIGNATURE / -, .s. DATE 6 d /APPLICANT PLE, E COMPLETE BELOW Quantity _ Type of Fixture Quantity , Type of Fixture Bath Tub with or without showerRough-ins Dishwasher 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§3268.148 ' _ iFEE SCHEDULE "SURCHARGE"has been extended' [job.cost with a$49.50 minimum Residential,New One&Two-Family $149.50 • Residential,Additions&Alterations $4950 The minimum surcharge for a 5O '• . "fixed fee"permit is$5.00 $ 5 Building Permit# -PLUMBING PERMIT FEE $ qq-k0 STATE SURCHARGE $ UN 5,00 (Office Use Only) TOTAL PERMIT FEE $ ✓'f This Application Becomes Your Building Permit When Approved .1. �. ( a Rei / for%, `I int Butldine_Official Da t l B,, J Date s 24 hour notice for all inspections(952)447-9854,faxa(952)447-6245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372