HomeMy WebLinkAboutPlumbing Permit 15. 1140 (1/ \
n i J § � . 0 ® nlEmoo D o g § 4
z� z m z 34
k � § � �§k� ��
g q �o� Q P o ,
q & ^ t 2 . m $ co 0§
\ § 7 z \ 0 k
o i 2 m
§ r o 3
73 - 14. m o 2
Z XI , 000000 44
77 x m m 01 Of mm ■ 11 ■ * ■ '
0 co �c � PE
7 0 K f m q § §§$ § m p 0
E > oo o § m
q U r Oo o
2 0 § k § k- 0 m
= xl
z m
a0
m 00000 � 0
E
R. 0 mmco �m
il
\ 7Z ; §
q mm m
� �_ ■ � -
z ■
-1r Q
Q3 PR/04, (.1 Date Rec'd
4.,ANI CITY OF PRIOR LAKE PLUMBING PERMIT
4NNEsd
'. Blue
City File PERMIT NC 2. Geld /� Hew
(Please type or print and sign at bottom) 3. Yellow Applicant /"
ADDRESS 3 owl
r1 V �OIS S ZONING(office nse)
�1 � l
LEGAL DESCRIPTION(office use only)
LOT 213LOCK Z 'ADDITION t e g e, s& pID p�f •3��� Ota 0
OWNER
(Name) (Phone)
(Address)
APPLICANT (
(Name) m e S k l A lm ar\ P t ULWlbi n3J 717,-1 C i (Phone) (9 ja- l gb $(p
C-1 .
(Address) 3 5-GF dr,seyr PkUt V.ek, (YIIV e'5A30
(Address) (City) (Zip Code)
(Contact Person) �. iR*t2 Oc,)rs (Phone) (0.[ — 0$D 0.3"02-/
APPLICANT SIGNATURE _Icy Ataia,Oj-�L}-,0 DATE /31)/6--
APPLICANT
3')'6APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity / Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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
Estimated Cost $ 1400 bo Building Permit#
PLUMBING PERMIT FEE $ 50
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ .50
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 6t9 'o :eiPt
N . /0
Date �n :2/k A S
Building Official Date ,"
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372