HomeMy WebLinkAboutPlumbing Permit 12-0130 — O O n 000000 - 0 o > En
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A CITY OF PRIOR LAKE PLUMBING PERNIIT
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Blue Flit I C P ERMIT NO. t
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING ZONING (office use)
5 `j) 33 Bo ( �. h SfQ
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER _ c^ �
(Name) e e c C.( e ( Phone ) 9,7 a- el l -13 7 7
(Address) 533_3 t O if n -- y 64 2 T
APPLICANT f / p
(Name) 7 i PA > u Ct I 1 0 1 u mb r' ►1q (Phone) 9 S� - /? 7 S . 3 7
(Address) C, .23 C e i' +'r4 / v4 e. tCseG hi N 5
(Address) I I (City) (Zip Code)
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(Contact Person) 1 1 1 L\ r�C J C • 'hone) 5Ci rY\ C-.
APPLICANT SIGNATURE 1 / i _ _ . A ��,_ _ 'z DATE ____0241./ja„.
' PLI 'ANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough - ins
Dishwasher 1 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
The Minnesota Statutes 4 326B.148 .Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010. until June 30, 2011. STATE SURCHARGE $ .50
1'he minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $
is Is beginning July 1, 2010
1
This Application Becomes Your Building Permit When Approved Paid 5, 7 / S - Receip o. .5 2_/
Date ` B y r/
Buildine Official Date z / 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372