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HomeMy WebLinkAboutPlumbing Permit 14. 0372 10 0X 0 000000 0 > § g 2 on * 0 ■ mEmmm 0 z § 34 k k k k 3 � � � E � § m m M omq § t 2 -9 k Z iQ G) • 0,, ICS -4 z — ■ § Cn • 0 » \ it > > 0 21, oo ' m m ■ r § 7 % m 0 73 X z z 00 �ir 000000 / \ 2mm E •o ® $ Em * ■ 0C -InC $ 2 3 ? 2 x2221 -mme m 0 _ ■ J E m § q as >000 3 z m q q o z % r 2 2 ■ 2 2 § m r § i o ■ 0 I m 8 o m X00000 z 7 ommn2 § , o© �� mm2o | � i 41 » .1 ri > ® 0 a22z . § m ¥YiT_ 73 � F -• m > z ■ -4r o I)I4 PRIO,� Date Rec'd EI) CITY OF PRIOR LAKE PLUMBING PERMIT v dr se I.Gold Fie PERMIT NO. /, Lz Cityp �:37L 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) g‘5-7 UJ4'c-ti uoakd k( (k) LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PH) ((NaOWNER ✓ he Vk k, t-JJI9 a o --g-7 7- (Phone) 3 (Address) 5-76 Utierce1C(dOC .i M Prior Lake tori 5637o-- APPLICANT 5 37 o-- (Name) ANTeXQ t ( / ` CR zlj•'�� (( //��lC (Phone)II lD``� � �� 0��� (Address) 34 `T V \I1DY— • 4LV5� WI 5 )0 Ic C `,�^(Ad (City) (Zip/Code) (Contact Person) 1`t '( 1 6 (Phone) C 5 1! ci 8- Oil`(cl APPLICANT SIGNATURE 7, ,.... 1 4.8p 4. DATE , l L 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 1 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 The Minnesota Statutes§326B.148 FEE SCHEDULE "SURCHARGE"has been extended job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 The minimum surcharge for a Residential,Additions&Alterations $49.50 "fixed fee"permit is$5.00 $ Building Permit# PLUMBING PERMIT FEE $ Li<. So STATE SURCHARGE $ _ ,"U TOTAL PERMIT FEE $ 0 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid ��--// Receipt No. L2... If 4 �P b Date ' "' By Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372