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HomeMy WebLinkAboutPlumbing Permit 15. 1308 01 J_ 0 � nn n 000000 34 0 a E0 § n 2 22 o 0 ■ � z � � � § $ 0 %4 » a xi c qz ■ziq§ z m / t m � � 2 m �f� � / XI roll 2� q q a 2 P 2 V ■ > Z2 -4 m o z- Q § z - s •• q $ o 2 \ 0 0 > 0 m / § X 0 z z X m 41 Z x 0 0 0 000000 E -4 K 0 CI 43 T mmm * cm c � mE \ k § ƒ m0 \ T ■ M } § m 0 7 co % 0 \ 0 > 000 0 3 -1 � m / / k � z // z / 0 k o rmm P ' v I ■ mfla 0 < q z OOO ❑ O E o � � n2 , - o < c kmmk® 2 q z x- A )i. \ § rn � mk � k OR � � x_ • / -1 ` C > z ■ ® r 0 PRI�� Date/Re:' d 1 CITY OF PRIOR LAKE PLUMBING PERMIT 0 *NES°� I. Blue File PERMIT NO. /j /�/G� 2. Cela City / +� /_`�+ 3. Yellow Applicant W (Please type or print and sign at bottom) ADDRESS t.46)62 (k k/' i ZONING(office use) l LEGAL DESCRIPTIION(office use only) {y LOT l BLOCK 3 ADDITION 60001 ( 4 -Y�$7`�s ,4 JJD 5- 3/7- �Q- OWNER & \!Q , _1. i0 3C, (Phone) ( (, — �-3 l LN (Address) "(f)S -)O(4003d 'D \_,I _ APPLICANT (Name) ---1)111s Sty nI1 s . )- ( r( C, (Phone) c63.-(1 3 ✓� /- a (Address) aV GO CO u at TZ qb, 5um 'Ji l.' ' 337 (Address) (City) 22 (Zip Code) (Contact Person) K v(Tie (Phone)��� �J APPLICANT SIGNATURE "/ DATE l OJ f 7/ID— APPLICANT D— APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher ( 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 $ Building Permitt'�# PLUMBING PERMIT FEE $ tf"f. STATE SURCHARGE $ $1.00 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid 66 s v Receipt No..3z06 Date -7 I ,� By Building Official Date '© . (i 1 24 hour notice for all inspections(952)447-9850 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372