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Rl Date Rec'd
Tim Chmiliewski PLUMBING PERMIT
; ',.;';, ',4 '
5900 Cedarwood Street Northeas
v' 4 Prior Lake, MN 55372
/NNESO�P 6128509036
I. Blue Fde
2 PERMIT NO 44
. Geld City / / 7
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5q 00 CedwrvVoo d a. NE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Na Ti CV) mil 1 C V V& k, (Phone) ( 0 ( 4 % ( 40 3(40
(Address) 5/O0 C1yJaflrvood 6t, N(
APPLICANT I 'n n / 2
(Name) Noy oy ✓1'6„ 1' 1, pti/tifyuoir (P hone) �� I ) b.7. 6 [033
(Address) ?q el ar -i eI el gp. nl, r/s (5`foff'
(Address) (City) �i'f (Zip Code)
(Contact Person) Qv /
(Phone) (CP 2.) U . 37
APPLICANT SIGNATURE 4 = DATE V t
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 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 )St $ PO' Building Permit #
"SURCHARGE" has been changed for one . 50
year effective PLUMBING PERMIT FEE $
lig July 1 2010, until June 30, 2011. STATE SURCHARGE $ .500
The minimum surcharge fora "fixed fee" permit / s( 1 50
is 55, beginning.luly 1, 2010 TOTAL PERMIT FEE $ ( ,
This Application Becomes Your Building Permit When Approved Paid .. 3-4 . _ S7j Rec: f o./ i I‘
Date 6. 3 / / B,
Buildine Official Date •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372