HomeMy WebLinkAboutPlumbing Permit 12-0072 = O n 000000 13 0 > E°
O � � —��� = * q $ )
CD § 0 0 0 2 rn §c$_} \ m § \_k
% §. m m ', m K \� g 0 2
* qq > 2 13 B ®2 0 /
w m
2 t 2 @ q Z z § 2
2 �$ 2a
% k z q z )/
n a o at
z
hi q E o 3 �
)
0 ..
3 2 2
z 73 o0 0X0000
\ q § m§ �� �; m ® t��
k -1 - ° ? &Km?& _c 0 e
0 « k il t•-, § % r, < m � z 77�7 m z ?
! 7 § 0 § %R§ % § / § •
k)\ z > C C z §
igi 0 7 m � �� g § §
m
—
0
la 0 R
\ C 0 '
§ % 000000 q
t X ommnm ►
\ / { § § 5 rn
A, $ m ; ; §
" z >mm
57 -r! -I
± m w E A
qr R
. VRI Date Rec'd
�, _ � CITY OF PRIOR LAKE PLUMBING PERMIT
1A'NESO2
I. Blue File PERMIT NO.
2. Gold City •
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 /636 A Y(( L
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER D ���
(Name) TM ltt f ' (Phone)
(Address)
APPLICANT
(Name)' i.)0 . iik 7 ( tI (Phone) � p /A 2 - 7 Ti i7
(Address) /l e& 7 4 ,4 @r,G ( ( mace_ Cr 7Z
(Address) (City) (Zip Code)
(Contact Person) /8 ‘ 1 7 /010"/ (Phone)
APPLICANT SIGNATURE ......I!!` _ / — z DATE �/ 2—
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 MQ\J - rS�v Ere- Backflow Assembly
Sinks PL✓ "EC: - 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
r . ' ' Thst $ Building Permit #
The Minnesota Statutes § 326B.148 5T.)
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ 4-41:,
until June 30, 2013, STATE SURCHARGE $ __ J .. ( a
The minimum surcharge for a TOTAL PERMIT FEE $ 5 0 F, 66
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid5 4 �� Re i t Nob 50 7
Date ( z By
'
Buildine Official Date l 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372