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HomeMy WebLinkAboutLA023510 ITl(. - VILL PERMIT TvPE: I 201 ~5 HOLYOKE AVE. ®P.O. BOX 957 I Permit Number: t~~'~~S~t-3 Lakeville, Minnesota 55044-8012 Date Issued: ~ (612) 469-4431 y-~~~~~~~,~~ SITE A®ES: (XX}`,f(X'tX ~'}r~Y~'~AL H ~ LLB LA. 1..ft.F tm 4 T ~,[t..d9^f~ ~ G~CY~TAL LA.k~~' {i(`~La~'' ~ST~#TFk~ 2~I1~ A~?T~ I fi ~ Obi ESGRIPTI®N: - - f~ a 4~~I t ~tKT.,~:R At~'T~R P1~~mna.~.~' ~'~rm.~: +ypQ ~ISC~T.,I;,f~.Rj~;i~il.~a Ptu~}~~.~.~ Wr~r~ T.vFjQ I+fFW ~~t~.t' ~~rz~l. N~azn:s~~r ~245`T~3? +~p~t~ts~ Rc~s~d~r ~Tumh~z~ fiTCt - REMARK~: - 1=EE ~iJMARY F~~ ~~~.5t~ WATER l~~`~£sR ~:~15,0~~ ~ub~rat~l. .k,.._._ $3t~. CONTRACT®R: - ~~~.nt - OWNER: ~~{~yy~ WRL~ ?L{i~3~~+~I+(~~'C~ {^~f'~1n T g E~~± ~T ?37 fi(3TTLU~I13 HOFj'S~ ~;.7~ l.J~ A. 9. L.2~~..1+...P7.I l.t l't. t~? 1.1'. ~,l1~lt k'3~ ~~i3tlTi~i 544 ~ X~~ C~~~) 5~5-~1~0 ~ t 7- _ T _ _ - _ ~ ~{~,~,'~,~iY '~~sx~~~:.~°: ~..7.`'1~ F,,r-!z~ --~i-trs I . e~`?.. '~:~i ~ i ~ .~7 .t ~ F'• ~l~nl~FT) At:.t.;1.J~T~1N~Cs ?'1:1: ~'~-?fi, ~F'F'~i'r~y~~.:~3 `Ti,ryT~i A.,~i`.l .~^~t~F:i:T.~l.•_~T.k ~FI~=,;t:_`,? }~i~- ~PF'~,IC;A.fiL,~: CITY t~r,~iN.~~t;~:~. AnI~3 t_:~~?i?1~~ ~.~'v"i?, ~~:?:3 T~~. ~7~ ~TP~`F ,E-'.11?.-,-i1~Izs s'{~~i.L, ~ ~ ~ ~ ISSUED BY: SIGNATURE PLUMBING PERMIT APPLICATION CITY OF LAKEVILLE BUILDING INSPECTION DEPARTMENT 20195 HOLYOKE AVENUE, P. O. BOX 957 LAKEVILLE, MINNESOTA 55044 ~ /S r 93 (612) 469-4431 DATE: JOB SITE ADDRESS : }`,~C (~,~-~~iylt~~~ ~1 !`.-t`, PID# :Y-~ /~-X~' S`: X _ X~,k ,~C T BLOCK: SUBDIVISION: _ LEGAL DESCRIPTION: LOT: { ~ :r APPLICANT: OWNER O NTRACTO (circle one) OWNER OR BUILDER • ~v 9~~a n t~ PHONE STREET ADDRESS• ) CITY' ZIP: • ~ ~ ~ r~ PLUMBING CONTRACTOR: on Ul~l CONTR. NO.r~'~ ~ PHONE: STREET ADDRESS: ! 5~2~~ % 3 ~ ~ CITY: , -ZIP:Ssy~~ NEW CONSTRUCTION OR EXISTING (circle one) PLUMBING SYSTEM (21): SOFTENER (22): SPRINKLER (23): STANDPIPE (24): LAWN SPRINKLER (25): INSIDE PLMBG CONV (26): ADDITION OR REPAIR (27}: WATER HEATER (28): MISC (30): FOR: RESIDENTIAL: COMMERCIAL: INDUSTRIAL: JOB COST: (TO BE COMPLETED FOR COMMERCIAL & SPRINKLER SYSTEMS) PLUMBING FIXTURES: (Indicate the number of fixtures installed) WATER CLOSET (O1) ~ SLOP SINK (12) LAVATORY (02=) ~//1,L ~ ~(~1 ~ WATER SOFTENER (13 ) DISHWASHER (03) i) f URINAL (14) ~lU C/.~ '/~~Q~VY\ s DISPOSAL (15) t SHOWER (04) ; ~ ~'~'„~_BATHTUB (05) _ _ _ l RAIN LEADER (16 ) WASHER (06) YL. / l ~ YY"~~~ SUMpHPUMPI (18) 7 ) LAUNDRY TUB (07) , KITCHEN SINK (08) ~ ~,e.-~~~-~~~~- OTHER (19) CLOTHES WASHER (09) ~ ROUGH-INS { 2 2 ) FLOOR DRAIN (10) ~ WATER HEATER (2 3 ) DRINKING FOUNTAIN (l f) r Applicant° s Signature: / DATE:~.~-~? PLUMBING FEE RATES: Residential Commercial: New Construction: $63.00 1-1/2$ of contract cost up to $10,000 and (62.50 + .50 surcharge) 1~ of cost above $10,000 plus surcharge (Surcharge =Contract Cost X .0005) INCLUDES SPRINKLER SYSTEMS) Repairs or Remodel: $30.00 (29.50 + .50 surchargd) Minimum of $30.00 (29.50 + .50 surcharge) Water softener: $20.00 (19.50 + .50 surcharge) Revised 1/1/93 !I l PLUMBING PERNIIT APPLICATION PAGE 2 OFFICE USE SYSTEM TYPE: METER: a yr NEW (81) SIZE ADDITION (82) TYPE REPAIR (83) SERIAL DEMOLISH (84) REPLACE (s 5) INSPECTIONS: ALTERjREMODEL (86) OUGH-IN (64) MOVE 87 ( ) ~ FINAL (65) (70) PERMIT FEE: ' PERMIT FEE: $ " ~ SURCHARGE : $ ` METER : $ S^- ~ REDUCING VALVE: $ OTHER: _ $ TOTAL : $ f~ ` r ~ ~ / / APPROVED BY : I Jr~~-~;, 1` ' DATE : ~/j ~ ~ R