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� Date Rec'd
_ K CITY OF PRIOR LAKE PLUMBING PERMIT
JvivESO 1. Blue File
2. Gold City PERMIT NO. 1 , 1
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
IS! 80 ^ la n i i RBI OF
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
R rl� ? 2 k- fi ir (Phone) g - q`7 -- ��%
(Address) i• it A J /a V I . r 1. • n _
APPLICANT
(Name) v v d74
(Phone)
(Address) ` "K nce Connections Inc
allasDanita Circle (City) /� (/15 (Ziip / Code)
(Contact Person) Shakopee, MN 5537 , (Phone) g5 " ` /gt ` - 2
. n
APPLICANT SIGNATURE MA JC. DATE C _ — ' �
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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 Dst $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ • 4 *
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ OD .
The minimum surcharge fora "fixed fee" permit
is 55, beginning July 1, 2010 TOTAL PERMIT FEE $ ,., - _
This Application Becomes Your Building Permit When Approved Paid .5 ro Rec No (0333.1--
Building Official Date Date .....i / / B •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372