HomeMy WebLinkAboutPlumbing Permit 11-1338 5 O' 0 20020 0 > E0
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R Date Rec'd
Le CITY OF PRIOR LAKE PLUMBING PERMIT
MJ NNES 0 � P
1. rile
Gold
z. cola city PERMIT NO. / / /33e
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S ( A " 1 Netior gat. SP
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ��++�� �� ! �� ''�� f l'��/ 3D1 C-1 / (Phone)9& W -/
(Address) C(/yYYe. Prl c r r-C 1 V 5 c5 ?
APPLICANT Champion Plumbing
(Name) # 61770 -PM (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
(Address) Eagan, MN 55123 (City) (Zip Code)
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(Contact Person) V '' v ', (Phone)
APPLICANT SIGNATURE DATE 1 1- (J 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower iglazth
Dishwasher ' ater 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 Lost $ cO 1 Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, PLUMBING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 54_ g v
This Application Becomes Your Building Permit When Approved Paid 4 S . D Recei ob L 1 9
Date f 1,( By
Building Official Date N
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
1 5(12