HomeMy WebLinkAboutPlumbing Permit #12-222 3 ❑ O� C� O�DOO❑ 'o O > zA
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�, � CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File pERMIT NO
2. Gold City � �
3. Yellow Applicant 1
Please or 'nt and si at bottom
ADDRESS ZONING (oflFioe use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � ' �� ^� —, /� l�" jj,�/l
(Name) � (Phone) ' .n� '�'`7 `7"l.�
(Address)
APPLICANT qppfiance C�nnections nc
(Name) (Phone)
(Address) S hakODee� MN 55379
(Addre�� .�03 (City) (Zip Code)
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(Contact Person) � (Phone)
APPLICANT SIGNATURE � � DATE � � � I �
,
APPLICANT PLEASE COMPLETE BELOW
uanti T e of FiYture uanti T e of Fixture
� Bath Tub with or without shower Rou h-ins
Dishwasher Water 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 5 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
�ost $ Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGE " has been extended pLUMBING PERMIT FEE $ �
until ]une 30, 2013, STATE SURCHARGE $ r . DO .�4
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
- --_
This Application Becomes Your Building Permit When Approved Paid �� � / �—f l Recei No.J_�3
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Dat� � � r � .� By
Buildin¢ Ofticial Date � �
24 hour notice for all inspections (952) 4d7-9850, fax (952) 447-4245
4646 Dakota'Street S.E., Prior Lake, Minnesota 55372
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