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rRio Date Rec'd
' CITY OF PRIOR LAKE PLUMBING PERMIT
x Wayne Perkins
V
- -_ �' 16517 Franklin Trail
4,/„. SO Prior Lake, MN 55372
'. Gold rile PERMIT NO. ( ( � 3
9524472893 2. Gold city ` 1
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I C.Q 57 Fran i c n Trc(, C
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) V V C Q/ ?t' U' F-1 h ,S - (Phone) l _
1 529 'T(7 " __5 / 3
(Address) 1 LP I5 11 rr�, I vt in I ra t t
( N ame) N Ot b i J ? k(K1 ») (Phone) ('? O2) g'24 ' -1 0 - 33
(Name)
(Address) 2R 05 C a, r`1't `a v St ) ' ► 1 p
(Address) (City) S" ( // Zi / p nn Code)
(Contact Person) (Phone) 0,1 2 ) � - 7, `�
APPLICANT SIGNATURE �i • DATE 1 1 / 2-9. / 1 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher I Water Heater
Floor Drain l 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
F •* ;—^ *°a r'ost $ FPO . Building Permit #
The Minnesota Statutes § 326B.148 / So
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $ ` / "7�g
year effective STATE SURCHARGE $ .50 -
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ ( l , l5
The minimum surcharge fora "fixed fee" permit
is 5.5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid , ipt No. .7-s-3
Dal B
Building Official Date ?/ . 1, 1 •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372