HomeMy WebLinkAboutPlumbing Permit 13. 0773 � 5
0 0 ' 0 000000 0 > �0
A n\ o o/ 0 en - ri E ""� o (7 �
0 > o JJ m■ g 7 - 1Z0)00 z
\ 0 0® m E � c 3 k} z / -�
10 § � \ > \ m 0 „ -- Z /
/ m . 73 g > . -1 z ■ § »
-n \ � k q 2
\ ►‘ r / 7N \ ' §
M 0 k '13 �`
m qg . . 000000 3
2 / q 2§§ \ / $� ®* ■� %
c >m r
\ 2 K / m ? ■ K m ?■
_ m n (1)
o n CO ■» @
2 m e ■ zk - xx z 2 ?
NI d} 2 r--nRR ® @ F % m
/ 2 s R ® k 7 7 /
k 1.3
o i 1 /- 17 � P m
\ / § � � 1
o
,a-'4 } oocEO ,4a
R. § Q�mn / m o
\ .�m�2 N r
n E -013
\ rn I% \ › / / §7
���� -I
A §t z ■
4 r Q
\
pRip� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
h
.
1 . Blue File PERMIT NO. /3 _ 9773
2 Gold City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
30 1 (9 ro u C' vc \re_, IV WV
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER `�-1
, )
(Name) 1 t CR, r\ f V" C — �Xf�'CJV S (Phone) G 1 Z -7 't Y" `( O c e
(Address) 0 q O / G rot, ��.. c-fr NW Pr^t' or L0 k s .--- S3 - 7 Z
(Name) f�Ci�.Cl��llY\‘ S Q 11 2 I (d�('j�, V �U VV\ b( (Phone) 6 -)---- Z d J +(D° �9
(Address) ( 79 k �U net V t I 1-- n 1 v i ��+ ►'1 3 2
(Address) (City) (Zip Code)
(Contact Person) (Phone) I )--- q 1 — 4 6 0 a3
APPLICANT SIGNATURE 9
DATE 7 1 I SI13
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher I 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
The Minnesota Statutes § 326B.148 t $ Building Permit #
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ l dig t .3---()
until June 30, 2013, STATE SURCHARGE $ >6. S 00
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ ,7 o ,S
This Application Becomes Your Building Permit When Approved Paid 5 - / g Receipt No 94 g
Building Official Date Date /�/ 7/1`7/)3 By
q
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372