HomeMy WebLinkAboutPlumbing Permit 15. 1326 4 o O
/ \ k \ $ o § 2222 s 0 > zg •
m� \ m Mr-i! k ; k �/
\ ■ $ 2 \ 3KEK P /1
$ / / z `
§ op z � 7.1
¥
% m o 2 2 $ a| m A
z
q
m m m§ §
0000.0
. 00
Itri1! / k �
2C) 0 C
$ o o 2 - @■ §7§ m 00 ca
2 O O
z 7
/\ Xi
A " rn m \ m c n o
rn 0
rn
z ■
$ § OOOOO
\ > OMME §
7 q E � � � ® it) m
\0� �\
af/ - /
-f,- K @
.. �
PR704, Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT /01• a6, . /3---
.
4INNESO
2. G
I. Blueold File CityPERMIT NO. /5;)52 ,
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
159°78 TcY-fcr5 Pc ill NVQ! /j
LEGAL DESCRIPTION(office use only)
LOT BLOCK (7 ADDITION?eq v C/e-�— PID 2.5 3,gD - O17, --0
OWNER
(Name) J-'erG) A 0eA1 nC (Phone) q52,- 55 - 1-V- iG
(Address) 15 a-78' 3e ci.c r5 path NW"
APPLICANT
(Name) Champion pcum e n j (Phone) G5 i-3to5 - 13140
(Address) SC:70 Dodd Rd Eagan 551x3
(Address) (City) (Zip Code)
(Contact Person) 1ebeGC.cx / (ctry►r1 (Phone) G.51 - 3G7 5 - 131-10
..------'
APPLICANT SIGNATURE . "'LW., DATE 10/g2 / 15
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-inj
Dishwasher ` ater Heater
Floor Drain Water ener
Lavatory(Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Bacicflow 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
lost $ Building Permit#
The Minnesota Statutes§326B.148
"SURCHARGE"has been changed for one PLUMBING PERMIT FEE $ 50 .00
year effective
July 1.2010,until June 30.2011. STATE SURCHARGE $ .50
The minimum surcharge for a"fixed fee"permit TOTAL PERMIT FEE $ 50, 50
is 35,beginning July 1,2010 �
This Application Becomes Your Building Permit When Approved Paid9Receipt Noj. - �' 1
Date nn 'I!,, s- By
TY
Building Official Date 10.
V (/��'S
24 hour notice for all inspections(952)447-9350,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372