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HomeMy WebLinkAboutg Permit 14. 0194 a 00 EN n 000000 V 0 3, ■ n n n \ 000 s 0 xizK � k � Z m � 4 Co r o x 73 73 icEz § m ■ �2 % r m m m § k■ § ■ ■ p� IQ t * > § .1 ni 00 � 0 � � q _ R 0 > 0 m m \ % 0 ■ ro3 � . -a - % m § § o 000000 41 il § m m a "0CA5E � E § ° © S qos ■ ■ 2mzs n r ■ § { Cn m i \ .� > 000 � 0 § 0 _ m 0 0 . X200 ■ LI § Z m m . \ r m m § m / X § k c 0 . 00000 Li E 73o 0 KnimE0 & i C Ela "\ rn rn 0 » gg4 . § m 22 � § § -cr 0 4 4RI0 -" Date Rec'd ti CITY OF PRIOR LAKE PLUMBING PERMIT I.slue pile PERMIT NO. /1/... 2.Gold City 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING ioffice use) CA1.a AT( D"-\ LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER / � 1 ' Z, (Name) O � � ' U�-' (Phone) 5 a `- i33 (Address) -t l l D` . � i , 00-24 in1u �_ ((Name) ' I a L ��7 �� ' 1OLOl ame v . . .�t�:IJT 1 �Ir_ one). (Address) `-C b _. t .T a _ &1' i 1 31 D I L, (A.. - s) (City) (Zip Code) (Contact Person) C (Phone) APPLICANT SIGNATURE L'. a DATE 1 < )11 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 1Water 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 if job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 The minimum surcharge for a "fixed fee"permit is$5.00 $ Building Permit# PLUMBING PERMIT FEE $ z19 50 STATE SURCHARGE $ 50 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid./7 � 761 Receipt No. 61 otJ T' 'T Building Official Date Date igth By 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372