HomeMy WebLinkAboutPlumbing Permit 11-1052 l
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4 PRi3 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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M �NNESD
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2. Gold City PERMIT NO. / / 05
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS SE ZONING (office use)
C0 Cod R:� � l�N I r
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID�' O3 -i—ej ((Name `O V )Wk (Phone) / SD . / / O 'S "7'` y
(Address) Sc / - Pr Lo 1 ON S 33
APPLICANT Champion Plumbing
(Name) # 61770 P M (Phone)
651 - 36
(Address) X670 Dodd Rd.
(Address) Eagan, MN 5b123 (City) (Zip Code)
(Contact Person) \?,"rkS 0 (Phone)
APPLICANT SIGNATURE ifri DATE 9-D-9-1/
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower ' ough -ins
Dishwasher ( Water Heater
Floor Drain " • - o ener
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
$ � ".'lam- d i)
r;.. " ^'°a Cost r Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid S Rece' t No. ^ � Z3 �
Date , (o , l ( (�`�
Building Official Date
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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