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HomeMy WebLinkAboutPlumbing Permit 14. 0726 1 \ - / B ■ IL ■ . ui E Ka �� � Z g555z o k _ % 0 ■ UJ © © 0 0 ~ kcr. (65 �� � . § ■ . 00Ooc _ 0 2 2 , / o x. a x ^ �\ & § ola ci D. a -I k JJ0 LC § z } g § � & B 2 — � § �_ $ � tla U - 0 w ■ ■ ■ ■ mom % U / 2 ■ U �3 � § § ifi % 000000ilik § § § z .,a a 11 46 > § § w o U U w 0 z o U z uo _ o R ▪ 8 § ; % Oz 0 w § ■ -Z P0g a• 2 « I- I- 4 % ft u-• R U) rzz2 m ICCl L "J1,1 ■ 2§ 1. O z 2 0 a 000000 C.) 0 0 E. O�ygf0� Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT Cmusdit. Gol FA PERMIT NO. /� ;. cola c;ty /"7 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) 51 i5 j4Td6(er) ba-k COY SE 7 LEGAL DESCRIPTION(office use only) /� LOT LOCK ADDITION 44. tI Oi 7411.0N piDR5-0 .3-40 a-a OWNEIT (Na aU 1 !A \JQ In (7 i1J vi (Phone) 05, 'W D" 4,7023 (Address) 4 Anne ..ems APPLICANT (Name) Appliance Connections Inc (Phone) (Address) 12850 Chestnut Blvd. (A pee, MN 55379 (City) (Zip Code) U52-445-4803 (Contact Person) (Phone) APPLICANT SIGNATURE irrn . r'41- DATE I I i )6 IAPPLICANT 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 1r -1 A. • I /1 • " • •" ob cost with a$49.50 minimum Residential,New One&Two-Family $149.50 The Minnesota Statutes§326B.148" Residential,Additions&Alterations $49.50 "SURCHARGE"has been extended The minimum surcharge for a Building Permit# "fixed fee"permit is $5.00 LUMBING PERMIT FEE $ ..FATE SURCHARGE $ TOTAL PERMIT FEE $ (Office Use Only) • This Application Becomes Your Building Permit When Approved tsti`s0 Receipt 14...g7 ' 6-3 to r By Buildinc Official Date 5-7k" 24 hour notice for all inspections(952)447-9850,fax( 2)447-4245 I / 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372