HomeMy WebLinkAboutPlumbing Permit 11-1031 1 ,1 :8 ; 1 1. 1 1 1 1;
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. VRio Date Rec'd
0' CITY OF PRIOR LAKE PLUMBING PERMIT
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Z. 1. Blue d A File PERMIT NO . 1
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3. Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I LL O \SO\ 0 Vs) LA v, Q__ 55-3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 9 e u t S •rw L (Phone) L.5 I g4 - a3 SO
(Address)
APPLICANT
(Name) CULI IGAN WA CONDITIONING (Phone)
6030 CULLIGAN WAY
(Address) MINN • N q MN 5 (City) (Zip Code)
(; 543 45
33 -720t?
(Contact Person) (Phone)
APPLICANT SIGNATURE DATE 5 - a ). - I 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 1 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
. *;„■a *Prl Cost $ (4 k9 • 0 0 Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ y . 50
until June 30, 2013, STATE SURCHARGE $ S. 00 -39
The minimum surcharge for a TOTAL PERMIT FEE $ .S4 . 51)
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid 514, eipt No.( 41' 7
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Date (� r I I y
Building Official Date l a' g i t
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372