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Plumbing Permit 15. 0215
- O O t n 000000 -0 0 > 2 n n O ■ � z "n - m § § 2 �q ti a ra 2 22 E AcEc _§ m 73 m �� k r o I m B \ ■ � � A ® §� / t . � § m 0 �- � z� 46 (\ \, o � k 2 0 • z , ' m -I r § £ 2 % m 2 0 § O 0000 , ...., § § m m C $ c 1 2 § © c _Inc | ? m q § ■ § M § m 0 E n 2 8 q > §§ 9 § E d m 42 § / $ r2 § § m q eJ c o § § § r ) r §-0 § § k / — o o ` . . } < OO ❑ 000 _ � kII 21 0 rq o a k 0E 41 mm0 . z isss > _ � . 4 pi � il„ -1F �� m 22 ■ § § --i r- Q 01 Rtp' Date ReedCITY OF PRIOR LAKE PLUMBING PERMIT �J v �4 sdo File z..Gold city PERMIT NO. `5 '7 /5 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) /yt! / 3 Vn1ka-e r edy., -ir, j� LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER i (Name) t2e ' j-)" //-e cks o,4) (Phone) (Address) /L/L/13 Weft -Q d0 7. 1\-/E- APPLICANT \-/E- APPLICANT nn (Name) 13tv2 S tike.6101".,' ('cc!( (Phone) (QIZ 7510_ 2255 (Address) L}15'31 P37" - L 2C -rz 7 ..57.00s7 (Address) (City) (Zip Code) (Contact Person) Y / a/Le r (Phone) Iol am— APPLICANT SIGNATURE DATE 3—) -1 5- APPLICANT 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 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 )st $ Building Permit# "SURCHARGE"has been extended The minimum surcharge for a PLUMBING PERMIT FEE $ � 5v g STATE SURCHARGE $ .50 "fixed fee"permit is$5.00 TOTAL PERMIT FEE $ This Application Becomes Your Building Permit When Approved Paid 5,75/ v Recei o. ('1 Date. By Buildine Official Date I Z-, 15 ' 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372