HomeMy WebLinkAboutPlumbing Permit #12-551 J
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� 9 CITY OF PRIOR LAKE PLUMBING PERMIT
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Please e or rint and si at bottom
ADDRESS � � ZONING (oflice use)
"7 � C� -C [-L,/��j` f �
LEGAL DESCR�TION (office use only)
LOT BLOCK ADDITION PID
OWrTER � ��� - Cj �' V ����CJ
(Name) c ��' � rn" , (Phone) �
(Address) S -P�
APPLICANT Champion Plumbing
(Name) �c �y 77(1-PM (Phone)
651-365-1340
(Address) 3�,7n Dodd Rd.
(Address) Eagan MN 55123 (City) (Zip Code)
(Contact Person) ��_JU^,�(1 (Phone)
APPLICANT SIGNATURE DATE S���� ��
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e ashin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEESCHEDULE
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
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The Minnesota Statutes § 326B.148 •ost $�'� .� Building Permit #
"SURCHARGE" has been changed for one
year effective PLiJMBING PERMIT FEE $
July 1, 2010, until June 30, 201(. STATE SURCHARGE $ .50
The minimum sisrchargc for a"fxed fe��" permit TOTAL PERMIT FEE $
is �5, beginning July 1, 2010 ` '
This Application Becomes Your Building Permit When Approved Paid Rece N. „�
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Dat ,Z� By
Buildine Official Date � • � '
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 �