HomeMy WebLinkAboutPlumbing Permit 15. 0220 0 0
nn 2 0 n ■
a 000
* t m x 0 2 X�o O O 0 n
? 6I ��\ � m>gsom m08 2 3 0 c$
" ' I 2 Nr-giztlil = x IR g9
$ 0 n20 0 (a 0 z a Om
, / $ ', " 0 z ,
2 I o ■
63n° 6IN - g
X ;300M q 0 q %r
MX
■ 0
ƒ p
� � ƒ \ � ' �� �0OO
¥ mr *■ "D
k mc
. 2 ( XC ;*. kms07 17 0 _
$ \ ��Ooz
■ n
o r � oo a 7 f
0
7o ri
8 r- \\ 1� c
$ P r
< §
$ z 2
> 000000 N
• Eii8g 8,)
"Tg f K
K\\g$ 4
Ogg
q 7
.■ •R
q, & I §
',/
V Date Rec'd
o.t.PR/04 CITY OF PRIOR LAKE PLUMBING PERMIT
v
1.Blue File PERMIT NO. �,- 27 r
fMV85Dit' 2.Gold City 1
3.Yellow Applicant
ease
or , •,t and s' , at bottom
ADDRESS �+
ZONING(office use)
i�1 ih(Ckk l�` ° lw
LEGAL DESCRIPTION(office use only) PLD
LOT BLOCK ADDITION
(Name) � '�W (Phone)
(Name) lv
(Address)
APPLICANT (Phone)
(Name)
(Address) (City) (Zip Code)
(Addre
di a
(Phone)
(Contact Person) DATE - ��• FAPPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOWMEM ,r i,a of Fixture
'I A,e of Fixture illErfini
1111111111111111 Bath Tub with or without shower _— Routh-ins
-11 DishwasherWater Softener
IIIIIIIINIIIIII
IIININIIIIII Floor Drain Stand Pi o e ashin:Machine
11111111111111111111
11111111111111111 Lavato Bathroom Sink IIIIIISewa:e E'ector
IIIIIIINIIIIIII Laun I Tra 1 or 2 corn artment sink �- Backflow Assembl
IIII _IIIINIIIIIIII Shower Stall Backflow Assembl Test
111111111111111 Bar Sink _ Other
IIINIIIIIIIII
1111111111111111 Water Closet Toilet
FEE SCHEDULE
Industrial,Commercial&Multi family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50Residential,Additions&Alterations $49.50
_ L �,� . $ Building Permit#
The Minnesota Statutes§-3'2613.-111(8—e
326B.148
"SURCHARGE"has been extended ILUMBING PERMIT FEE $____ �-- C
The minimum surcharge for a ;TATE SURCHARGE $
"fixed fee"permit is$5.00 COTAL PERMIT FEE $
Re1No. z,
This Application Becomes Your Building Permit When Approved Paid 54/
miliagi
Building Official
Date Date , 13,,5 a
24 hour notice for all inspection (952)447-9850,fax 952)ota 55347427-4245
4646 Dakota Street S.E.,