HomeMy WebLinkAboutPlumbing Permit 15. 1118 0Ci n 000000 11 0 > E
0 ■ II2itnn 0 & o 50q
o n k k k 2 m ,„ c c 0 m m m \On
b R 0 0m m § \Ez■ 0 ■ ■ §�
® r mm ■ 2 Q� ® z -
% k § ° z 0
q 0
72
% 03 Z o C) 0 § x
"I 0 Z - rc
% 0 r z §
r o
3
0
% k 0 0 0 000000
X - mm � � � t� r
OS c
a co 2 § mX § m O CO)
% k m 0 > ogoo k z z
0 ---
.1, 0 r -n 0 2
§ § ice $ 0
/ m
oI.?ii 0 . 0D0D
z 0 kzko § m
> Q 0 c � 11 �
Ni i mm �§
$ t2§ K� 1::"--
_
R +- x 21 ■ r s
( -1 0 m
r
CiYRIOiDate Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
tIK.67 q' (L(` (`
1.91ue Fitty ! 5//,If
e PERMIT NO.
Cold Ci
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/7o4 Map62 La 5537 /31,56
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PU) c,laid- 067-4
OWNER s3e dmQ S/ 1 if i / (Phone) '?(.5.;~8026--Y4.5
`5/
(Address) ~- 50 nit,€
APPLICANT A [tat/ire
- / 95P- 44 5- 4 803
(Name) 1-1V Co/tried1 C'-Ls (Phone)
(Address)0850 C40471 Of Blvd 65379
(Address) (Ci ) (Zip Code)
(Contact Person) c,M 1.`elo pe,` (Phone)c— ,
APPLICANT SIGNATURE ,t DATE 9 /4 1d0/5
A PLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 0 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
The minimum surcharge for a :,UMBING PERMIT FEE $
"fixed fee"permit is .00 CATE SURCHARGE $ ' O
DTAL PERMIT FEE $ c58,
This Application Becomes Your Building Permit When Approved Paid 60 co Receipt No. '"11/46i
c
Date (24✓ �.. 5 av
Building Official Date < c
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372