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° CITY OF PRIOR LAKE PLUMBING PERMIT
0.4 x Jeanine Stenshoel
4303 Coachman Lane Northeast
al in'NEsd c * Prior Lake, MN 55372 1, Blue File /
9524473071 2. cold City PERMIT NO. /! 57231
3 Yellow Applicant
(Please type or print and sign at bottom
ADDRESS ZONING (office use)
4 C Oa
dar'la r L-046 N e .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER D, (q'5) L/ /� V ON (Phone) `( 7I
(Address) + • C darY1 airt L e I\1 E-.
APPLICANT
(Name) NORF3LOM PLUMBING CO. (Phone)
(Address) (612) 827 -4033
2 05sGARFIELD AVE. SO. (City) (Zip Code)
(Contact erson) MINNEAPOLIS MN 55408 (Phone)
APPLICANT SIGNATURE J , DATE l 1(../1 1 1
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 I% 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 $ $DO • - Building Permit #
"SURCHARGE" has been changed for one r �� i
year effective PLUMBING PERMIT FEE $ `Tv( ,s_0
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .500
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ 5Lt , $_
is $5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid 5f Recei No.( 3 f I 0
Building Official Date Datt f By O
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372