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HomeMy WebLinkAboutPlumbing Permit 15. 0087 � § § ] ■ mc, 4 u � \\\ � > g's < _ ■ WWF 0 _ m C k00000 CO ° 0 11) 0 0 a. aw. m k § 2 2 r § 2u. MI*. ID z 0 0 \ « k § � E � �� � w k 2 2 ■ U a %§ � § § § 2 27 2 a § § ■ ate o o & z 000000 2 2 § 111 k a a. 0 .1111 111 uj k 2 0 § z ° o § ' 0 § § g $ § © 0 0 § § w 2 © O.\ ■ \\ I � 0 1:tre ie; 0 0 ts / uj z 0 0 Z 000000 0 g uz « 0 a 000000 U a� PRtO� Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT !S. 1. Blue File 0-/ 3. 2.Gold City PERMIT NO./5, ( 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) zfr 411 4111 .1 LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER /7/ ,a C� (Name � (Phone) (Address) Val v APPLICANT (Name) Champion Plumbing (Phone) (Address) PC 000308 (Address) 6b' 3bb 1340 (City) (Zip Code) d Road (Contact Person) Ca _ f . (Phone) APPLICANT SIGNATURE ~ 40 �— DATE /W5///4" APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower ; . , $s Dishwasher iffe51711Ms� Floor Drain 1, :-"11149M-IFer Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) Laundry Tray(l 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 'st $ Building Permit# "SURCHARGE"has been extended PLUMBING PERMIT FEE $ The minimum surcharge for a STATE SURCHARGE $ .50 "fixed fee"permit is$5.00 TOTAL PERMIT FEE $ This Application Becomes Your Building Permit When Approved Paid5jl� Rec ' t No. /c/fr, Buiidinn Official Date Datel Z?. BY • 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 `��