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PRIp Date Rec'd
e CITY OF PRIOR LAKE PLUMBING PERMIT
7
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I. Blue File
z cola city PERMIT NO. / / / ` V3
.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5c 99 bos.,4,r\ S !&
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 11 . / h 1 (Phone)
(Address) 3eAAyv-e _ r1 Os( L Le- i 1 ' ` Q S5 3
APPLICANT Chart piurl Plumbing
(Name) # 61770 - (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
(Address) Eagan MN 55123
(City) (Zip Code)
(Contact Person) • 1 S _ . (Phone)
APPLICANT SIGNATURE �� DATE h (''
aS - l1
1, l
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Re -ins
Dishwasher
1
Floor Drain Wa e - • ' - er
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
Estimated Cost $ v)--00 _D a Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ C .50
5
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ L i, $
The minimum surcharge for a "fixed fee" permit
is i5, beginning July 1, 2010
1 ms Application isecomes r our minding Permit When Approved Paid /) , Rece• t NG 44
Date/ y
Buildine Official Date 1 ( i iJ l 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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