HomeMy WebLinkAboutPlumbing Permit #12-329 � ❑ ❑ (� OQ❑OOO � O D Nc�
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� �� CITY OF PRIOR LAKE PLUMBING PERMIT
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��NNES��
1. Blue File pERMIT NO . � ��
2. Gold Ci[y
3. Yellow Applicant
lease or 'nt and si at bottom
ADDRESS �� ' ZONING (ott use)
'�..J � �
LEGAL DESCRIPTION (ot3Eice use only)
LOT BLOCK ADDITION PID
(N me) 'c.�� � ����� (Phone) 6� � t'7 � (��, f T/
� L�� � �---
(Address) d�
�Pr,�C�vT Champion Plumbing
(Name) # 8177Q-PM (Phone)
651-365-1340
(Address) 3670 Dodd Rd. '
(Address) Eagan, (City) (Zip Code)
(Contact Person) c ,�.�C�l�l 1^ (Phone)
APPLICANT SIGNATURE DATE �'� v� 1 4�"
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Figture
Bath Tub with or without shower R
Dishwasher ater Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin 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
The Minnesota Statutes § 326B.148 �ost $ , � tr, Building Permit #
"SURCHARGE" has been extended pLUMBING PERMIT FEE $
until June 30, Z013, STATE SURCHARGE $ .50
The minimum surcharge for a p
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ �,
This Application Becomes Your Building Permit When Approved Paid 1 � R pt No� �7 (a�
.7(Q Z/
Date �� �� ( �
Bnildin� Off'icial Date •
24 hour notice for all inspections (952) 447-9850, fax (452) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 �