HomeMy WebLinkAboutPlumbing Permit 11-1087 a n 000000 20 L :*•
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° r '� CITY OF PRIOR LAKE PLUMBING PERMIT
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4 7471iase I. Blue File f
2. Gold City PERMIT NO . i / 10 01
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14 to O (mo6*.cLW141.. COUP
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIN
OWNER r+
(Name) JO.' l' k• (Phone)
(Address) j IC 7 a P.0 e c i• el" i C n k 1-- e r ,<o Pic..- i nih ff, 3 7 Z
APPLICANT"" QQ ���..., p r+_ s� 3 .7 9/
(Name) t v e 12V�- sb' `7t� c 1 K►titV) t` �1S (Phone)
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(Address) '17 $6 G ✓'IrvtW i Cam. Y�.UJ�. N Ockv . L. pit, _rvZg
(Address) (City) (Zip Code)
(Contact Person) 9 h I y LAs (Phone) ..fl -1*- Z 7/i 9
APPLICANT SIGNATURE DATE 10 — / `/ — /l
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture 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
The Minnesota Statutes § 326B.148 .. �s{ $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ f'Z)
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ if I 0
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ 5 bI
is E5, beginning July 1 2010
This Application Becomes Your Building Permit When Approved Paid 5-�§ Rem' No. C9 4,1,6 G
Date O ` . (/ B
Building Official Date
,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 C
4646 Dakota Street S.E., Prior Lake, Minnesota 55372