HomeMy WebLinkAboutPlumbing Permit 11-1192 J
0 Z 1� W
P J LL ~ V
~ *=vv < w
Z < 0 CI 4t
W d p z Z
i `-' 0LLli0 W N rt 6-
4
:30othc 0 O
Lu
w n n < �� = c 0 W
p � ' a' t 2 Y r z a d 0 j F 0 0. W Z z 2 — _ W A N
a' LL cz
CO O V d M 0 I- mxtuw== O O Z X O 0 0 UJ sal re Lu 0 0 0 0 ❑❑ W
.1 a. a O -
a a. 1 . 1 -
�
1 }oni
o Z .� o c r y arA 111 ill G O ti at IL �`� a
O Z i O 0 W I — 1 I < < W
Z V , < 0 N Z N 0 W L J i=4 0O co K = 0 np4 - < W 0 0 t V V
O a 0 w O OLLu3t 0 0 0 1.
}? O < 0 N ❑ ❑
d 0 ❑ODDO 0 5.
( ,--1, RIO Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I�' NESD P
z. Gold city PERMIT NO. / q 4
(Please type or 3. Yellow Applicant / � . `! /
(P typ print and sign at bottom)
AD�RE SS 1/0
ZONING (office use)
CPI (4 °/ 0 �S p } 17 3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) OWNER � . ,A ' i ,� �./
(Phone) ?C � / ONO
(Address) Savv Pr Y L'-/ i • ' ' i Sgi3
APPLICANT Champion Plumbing
(Name) # 61770 -PM (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
(Address)Eagan, MN 55123 (City) (Zip Code)
(Contact Person) /\ t� (Phone)
APPLICANT SIGNATURE _ / // DATE F V -J / -!
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower ; ..
Dishwasher l - -,I I--,ter ti
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
Estimated Cost � Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ .50
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ 6c--/. 5 b
The minimum surcharge for a ''fixed fee' permit
is 5.5, beginning July 1, 2010
A ..ID rrppucaaiuii Deuuulea r our nuilding Permit When Approved Paid `p� V j ( ¢
c- '"� - Re e pt No. / b 4
Date / ( B t
Building Official Date v .. v ( •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372