HomeMy WebLinkAboutPlumbing Permit 15. 1380 J
W Z 1 �
LL r W
= W W a 0Z ki
W w !�r 0 W W N z a w
< `' - w V L T. 0 E i
w re
A . ❑ ❑ ❑ ❑ ❑lam
`s 11 W O
S
v
LL N to
OW Z
aaJ m O
C 1 E 09LLJ o U o 4
OO a
_ z rx z _ xxZZ w ° H O
iii 03 re re Ct m LL r.
N 0 a xV ~ WzV O O Z f' O
JWQ JW W W I.W X fs,
a23v) a2 v v a z
j 000000 a 0 0 o z ,v
a a W 1-
•
J
Y V Z O Z
v Q
2 W
V O lit
gi= 0 LL
O Z H Vf-
o = O Z w N
n O
I
OFO I— F
� Oa Z ` I-
ca v
a = � ° Z W ,_ ILI
CC CL Lo: Q
IL vH 25J �W WO0u. ' ZWOoc Vc
OG W LLu. tA= Fd0 O E.
O L0 ck ,,
Q = V
a ❑ DDO ❑ ❑ V ❑
I RtpDate Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
gOros
I.
Blue File
.YelAPERMIT NO./3—
3- /✓ O/V3.Yellow Applicant
(Please type or print and sign at bottom)
altbDRESS ZONING(office use)
% 7 (114412,6A / kJ L ,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER l ( V C 1 C (/ e (Phone)
(Address)
APPLICANT t Lt L is 711/4-j y� G< '` '-L/(i 0— (- z J
,Fame) S (Phone) J
(Address)
v4C=11 c►wc..✓a 2 Lr-1r�E k-t6.1.. Ss.�
(Address) (City) (Zip Code)
irk n-rz_ 44-40e
(Contact Person) (Phone) t
APPLICANT SIGNATURE C./ _ DATE )
/ /6
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 Permit#
PLUMBING PERMIT FEE $ q`
STATE SURCHARGE $ l.
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5.12,
q) Receipt No. 337
Building Official Date Date it. )/0 s' By �✓��'"_'——
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372