HomeMy WebLinkAboutPlumbing Permit 11-1317 = o Nic 0 0 00000 - o a zg
\ 0 0 o 2 § ƒ0 2 00 z m k rn
2 / a. Xq 7 =rte "" m qm
mm m z
§ t % -I § § ® P Zk
10 -1 > - @ q z 2 § ■
w a
¢ Oa
-^ n } d mm
§ 2 r Z X g -4 m k k o ooO ❑OO
f / m // � m -o
2 §D 0 it n §
2 0 k E m -n § 73% m 0 0
% m § > 0 § -4 m
]\ 2
I
3 2 9 - Z , E
§ 2 § m >§ % Z 1 b
/ § m I Ni -
§ § \ X00000 `
m o22n 0
R. v 0 - §k
4. < >
q 0 a00 , .K
q • m � � r §
- / K
j
(jvRIp Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
'C-
- -': - Steve Fransen
5290 Summer Street
41 'NNrscW" Prior Lake, MN 55372
'. Blue File PERMIT NO. ti ( 317
9522263542 z. cola city
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
s 21 o Sculturri or &feet
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER OWN st_"e/ v �^ l �� `'r l� (Phone) ( 5 2 � 2- ' 3 J a N ! c y�
(Address) 5 0 V �� (� , l e'r e e,e4-
APPLICANT. l b • (Name) Ni I ` b l t y 3/L' pr t,urn 'n (Phone) C � (f 33
(Address) 2J10 5 G CL r ad_ 94--ve c,!, 4 1 S o c/L O 0
(Address) (City) L (Zip Code)
Person) (Phone) C 111 Z Q � U !/l ' `4 0 7
APPLICANT SIGNATURE /AI& _ DATE 1 2i1 1 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture s 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
P'e*i” 1 Cost $ O 0 . Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $ 1 41 .
year effective STATE SURCHARGE $ .500
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ 5 '+. 50
The minimum surcharge fora "fixed fee" permit
is 55, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid 5 ( 4 S Receiil o./ 4 — 157
Date 1 _ 1 I By
Buildine Official Date J '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372