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HomeMy WebLinkAboutPlumbing Permit 15. 0804 . 7.3 —1...r_ A i .. ceu. IZ Iii F.kri F" WWQ 7 P=VC) W C 4. 1 ,111 LI Z 4 c.) a ri. L) , E 74; cu rt x O N W .�. Z p� la O C aaQ O V W — a W Z YYO? ` ~ c a M 1- F 0 0 0 0 1 r ii,a ? occo 0 _ W �,() ,— : u' C C Z X 0N C) a 1 la < j V W W K cu Z w W Ce W , a.00000Te W r• e 0 (‘'"*-0 rj_ • z a O kl 0 0 a0 10 Y� o 0 1 1— 6 WoD O O IX Z W F' F 0.z � 0Z N W W 0.1_-_. ZF. � z ILI J : q Z F- 2Jgul v u. c5 o 00 V OWp W Z a. O� HO y 0 u.u. u. =L N V 0 a < avZ 000000 V 0 � E°01 4rRroCITY OF PRIOR LAKE PLUMBING PERMIT Date Recd 7r sol I.91ue File I PERMIT NO. ' I (Please type or print and sign at bottom) 2 oo,d City /�ago 3.Yellow Applicant , ADDRESS 5 7 Q' 0:( K 4 ZONING(office use) LEGAL DESCRIPTION(office use only) LOT 61BLOCK / ADDITION S,�N.h �/p ,4 !1--` Add ID ac�'' 239- o/5/- 0 owNEz�. �-^ (Name) �.J- PW—It t - -7C2- yS C� (Phone) � (Address) APPLICANT (Name) Appliance Connections Inc. (Phone) (Address) 12850 Ch;'stnut Blvd. (Address) g52_44i -4$03 (Cita') (Zip Code) (Contact Person) A( i) { ''':' , (Phone) APPLICANT SIGNATURE -"1"....1 'A i #/11 e7/9) //9' I r DATE APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type Bath Tub with or without shower of Fixture Dishwasher Rough-ins Floor Drain L Water Heater Lavatory(Bathroom Sink) Water Softener Laundry Tray(1 or 2 compartment sink StandwaPEjectore(Washing Machine) Shower Stall Sewage Sinks Backflow Assembly Bar Sink Backflow Assembly Test Water Closet(Toilet) Lawn Sprinkler Other T}ze Minnesota Statutes - FEE SCHEDULE "SURCHARGE" §326$'14'8 )doll cost with a$49.50 minimum Residential,New One&rwo-Family $149.50 has been extended Residential,Additions&Alterations $49.50 The minim tun surcharge for a "fixed fee"permit is$5.40 $ Building Permit# PLUMBING PERMIT FEE $ '.. STATE SURCHARGE $ XXX 5.00 (Office Use Only) TOTAL PERMIT FEE $ 5ti.co This Application Becomes Your Building Permit When Approved ( aic LA -�© Receipt No. ? 1 i Buildine Official Date (/1 Date '1 * t]] .' By 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.R.,Prior Lake,Minnesota 55372