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HomeMy WebLinkAboutPlumbing Permit 15. 1134 100 n 000000 0 i g 2 0 © ■ s 0 � g71 028 71 11 li z m z �/ k r R 73 k k nirc § 77 In In 73 VA 7-4 13 tvi r n � ■ 2 � oqQ P 72z- % t > q _ z §m 7 _I. 73 § 2 § $ 9 q me m m 0 _ 7 0 r k - � it "V If % m 2 § o 0. 1 000000 Z m mm m m 111 � r � s � r I k m §_ �§ � � � 0 0 ) 2 0o § z § � B § t m , \ § % § .� � z \ X - Z 1 r ® 0 o co > ic P • m § R q a. 0 � /' a_ g 0Oo ❑ OQ m Q � � n § W § 2 a § cornmEo -- m k � o k 0 s22 ■ � qn mMXr m - - E ■ 4r 0 o s I,RIO`S' Date Rec'd F CITY OF PRIOR LAKE PLUMBING PERMIT ,lz/L IT J17INNES��A I. Blue File 2. Gold city PERMIT NO. /1- --4- // .Z'� 3.Yellow Applicant �l (Please type or print and sign at bottom) ADDRESS ZONING(office use) L55(o •l-iurbtr gt KiE "PUSb LEGAL DESCRIPTION(office use only) A./4,A_ R5-7-' gLOT 'BLOCK / ADDITION 6xa ,Qi PID ?5 — Z�p 3—O07"-O OWNER . // , `� ► �j (Name) --r=' 114 11 t-in kt o (Phone) (6/—o7/0-0g60 (Address) (05 (j I rbar etch K APPLICANT')�L ,� (Name) 11110.00()T1 i) In bi (Phone) (OSI -3[95- 13610 (Address) 3(010 td(i 1Ct S(.l,l" 41. 1 etl ,p.,r 6 IP? (Address) (1 (City) (Zip Code) (Contact Person) (Phone) //I— / / _ APPLICANT SIGNATURE �� DATE /7/IS APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower ' , g - Dishwasher I Water Heater Floor Drain . - -o-ener 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 ost $ Building Permit# The Minnesota Statutes§326B.148 "SURCHARGE"has been changed for one PLUMBING PERMIT FEE $ 0,b.0 year effective STATE SURCHARGE $ 50 e' July 1,201D,until June 30,2011. e. The minimum surcharge for a"fixed fee" permit TOTAL PERMIT FEE $ 0 e 50 is»,beginning July 1,2010 This Application Becomes Your Building Permit When Approved Paid D Receipt Nc(2,9\9A Date n ;-:6.y - By C Building Official Date l� l ) .. 24 hour notice for all inspections(952)447-9350,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372