HomeMy WebLinkAboutPlumbing Permit #12-277 � ❑ p� n �00❑❑ � O D ZA
� � n � O u►,+Z�oo O � ° v ��
n o o p 3 -�zv,�co m m m m0
b D o ��� 3 m ��3z� Z � �, �,�
� � m m y 1'T1 N szyZ p y p�
�e � D Z � 'n_I� Z�
p � n y (�/� � Z Z ,� 0�
� a � O n Z O A
z � � mm
� � � Z �
� r v
_ � �v �v
� �" � o o ❑❑❑❑0❑ -�
m m m m 3 � y ��� s
p� "� u Z i ° ° nC�'�nC ` f
� �c z Q � ����_� m p t- c
� C m m ..�� y� = pp�� 3 � ��� o
D° n � p r�00 � � . C
� � o z � zC� z r
z � m ��� � o
� ^' O
� A �
= m
� c c� �-- -�
N < ,�00❑O❑ N
y z � �T?1n� f � -�i
� v � Crr �� � � m
D mDDDp � �
Z nC�Z
� m ��m. �
� � ��� � �
m
r
� � �
��
���� �
� �Rrp Date Rec'd
,°'� �� CITY OF PRIOR LAKE PLUMBING PERMIT
� .:. �
U'
��'NESO�
'. B1 i� F "` pERMIT NO. --�� �J
i. aoia c��Y / ��• _!
3. Yello�v Applicunl � � � `y
lease e or rint and si at bottom
ADDRESS ��r��� �� ZONI�TG(oFficeuse)
l� Z� 5 � ��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITIDN PID '- y�� ` �' Y� � �' � ' �%
OWNER '�]1 - r , �' t � � /',,(�' �
(Name) (Phone) / I `j..� IU�I �
(Address) � � �i ��� �-tlJ +� Y "vL ��`� /
APPLICAN S � I
(Name) (Phone) � I y �
(Address)
( ddress} (City} (Zip Code}
, f� `�
(ContactPerson) {Phone) �l/��'� 1� � I�� _
APPLICANT SIGNATURE DATE �
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Ftixture uantit e of Fixture
Bath T�ib with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e ashin Machine
Laund Tra 1 or 2 com artment sink Sewa e E"ector
Shower Stall Bacl�low Assembl
Sin1�s Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Ctoset Toilet Other
F'EE SCHEDULE
[ndustrial, Commercial & Mulri-family l°/a of job cost with a$49.50 minunum ', o-
esidPntial d��r+nn & Alterations $49 50
•.� -�
The Minnesota Statutes $ 326f3.14R ��st $ Building Permit #
"SU[tC.FIARGk" lias been eh�n�ed for one
yenr efiFective PLUMBING PERMIT FEE $
.lut,y' i. 2Qi0, uhtii 3une 30, 2011. $TA� S�C� $ ""'
'i'he minimum surchargetor A" fizcd fee" permit TOTAL PERNIIT FEE $
is ,�_i, be�inning duty 1, 20I0
This ApplicationBecomes Your Building Permit When Approved Paid ✓—� �� Rec t No. �,s �^ �
Date�
Buildlne Offlcial Date �
Z4 hour nodce for sll inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prlor Lake, Mlnnesota 55372