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HomeMy WebLinkAboutPlumbing Permit 15. 0550 n 000000 D 0 > E0 i5 00 g qzK� �� X S k 53 am/ 0 x 71 kkk m E� �.$0z Z (n 7-I "0 ill r 00 0 Z $ -I ® q ® P o7, %00 % S a - z g §$ ' !0F1fl (A r 0 3 k0 0 . lit ❑ 00000 % rn m M M sm ■ ■ ■ 1 0 x m m nc2� oc ! " X § mXMXI x SR m 0 U) % 0 a 0 EZXX - Z 3 z X E m 0 0 r -nOo ■ q . . 2 q - 0 0 'k § c c Z m / 2 n § . rm .0 P mo .11: 0 • § § � r.)§2 .1Ii K § §B " m ■ � r § m a) $ - § § -Ir © 04 PRI% - Date Rec'd it,/he., CITY OF PRIOR LAKE PLUMBING PERMIT lNNESO�� 1. Blue File 2. YPERMIT NO. ' -- l� �� ] f� 3.YellowlAp Applicant (Please type or print and sign at bottom) ADDRESS �� ---G-Q � ZO�M�(office use) ‘,c-KG-,5 N� LEGAL DESCRIPTION(office use only) -��^ LOT BLOCK ADDITION PID o--J ' 1134'O� 1° OWNE .� _ (� (Name) Cv C"IN- .•(1\SO Y -- (Phone (Address)` 3 (r vat\>k3\QA\-- , .K..) APPLICANT11� (Name) h �1 f ©RJ`- \AA _� one , dr `L 1 (Address) \ - C Cl\ , l c_, A VIIIMIRWIECE (Address) (City) (Zip 'Code) (Contact Person) A W[ILA_ ` • O )Vv\Cx.\A,V\ (Phone) qC(a- Z (1l44 APPLICANT SIGNATURE fil DATE APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher 1- J( 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 Estimated Cost $ Building Permit# PLUMBING PERMIT FEE $ / ,J- STATE SURCHARGE $ $5.00 TOTAL PERMIT FEE $ e9-{_s-C) (Office Use Only) This Application Becomes Your Building Permit When Approved Paid aLicsv Receipt No�/--f 59 Building Official Date Date 5 2_,1`ec- By l 5' `"" 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372