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HomeMy WebLinkAboutPlumbing Permit 15. 1551 J W Z Z ~ rz J � tiix U _ ft = VU z 1 X55 = > 1n O2 W WN O 'C 2 .�- 1. W V 1i. 1i 0 CZ Z D M ❑ ❑ ❑❑ ❑� WN 0 II Vix 0 W u. N O \ W L Z J 0 » Z Z G O K Ca m F YYLL J p U V G a' — O < d� p y w t `' W z a' _ " Z ? W y a. a a. z co 1 U a. _1W < y6j5W •, W W z X o4 .1 a � 3ya2 v v w z a ❑ ❑ ❑ ❑ ❑ ❑ a0' 0 O ce W `C a a a t2 p J ix Z >: J a' 0 44 0 IL 51 o 0 c) 13 re Q Z Z U Cl) F= < r• W O Z O O a i_ <co V AG LLO N ci ca 5 Z F- Z ,ej < W s= ce ce w o < U Oa o o � � �= L' U p 3 c°) c°) y �❑ ❑ 5 c� ? a 0 x ❑❑ ❑ ❑ ❑ ❑ C.) C/ • of PRIo� Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT tZ3 ‘E 0, 2ettS ,t'NEso 1.sae FA I PERMIT NO. (lam , ii z.com city 3.Yellow Applicant (Please type or print and sign at bottom) ZONING(office use) ADDRESS `1 3a (, Lake 1-Fo.uen CG( No, Pricer Label Ictal SS3 7.7- asi J LEGAL DESCRIPTION(office use only)• �}) 1 LOT BLOCK ADDITION PIDC Sn 37/. O/D v OWNER ,..‘ 1 (Name) .... art A a G K (Phone) 4S 2 '1'1� - 3 6 2)3 �0.v i (Address) 3 O Co L oke Way en C t Nu.1 / P r i o r L0.k e l it S`S 3 7 a- APPLICANT , (Name) c t.G.rn a a C.,is (Phone) 4-47% ` 4 iO - 3 6o3 Dau �i d 8-6 1-6-14e- ( �1 P/t CA" t'r;of L L e 5-5 3 7 01 (Address) (Address) (City) (Zip Code) (Contact Person) (Phone) APPLICANT SIGNATURE DATE 2 O FG 2-c7( 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 $ `-CII •' STATE SURCHARGE $ $1.00 TOTAL PERMIT FEE $ w© sO (Office Use Only) This Application Becomes Your Building Permit When Approved Paid 5,0 6-0 Receipt No r .e...)09 Date 0 �1(ct i S' � " ' By Sem A) Building Official Date `�'( 24 hour notice for all inspections(952)447-9850 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372