HomeMy WebLinkAboutPlumbing Permit #12-0680 y ❑ ��j C� ❑O[]�O❑ = O � N�?
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� �� CITY OF PRIOR LAKE PLUMBING PERMIT
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3. Yellow Applicant r� ��
lease e or ' t and si n at bottom
ADDRESS � ZONING (ott'ice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWNER 1 �'1Q.i � I V �.Ib� � (Phone) ���'� ��7 � 4 �
(Address) � • � �� �
APPLICANT t ',,,�,� �/� � /� � s � �' � 2 � ( b
(Name) � Wr � 1�1 v L (Phone) lD'" J 7,d ���>�-C
(Address) ' � 'v � 1
(Address) (C' (Zip Code)
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(Contact Person) J (Phone) � ✓� ��� l � �
APPLICANT SIGNATURE DATE ` I � �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture Quanti 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 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
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
�st $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended pLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ :5�
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid �� �y}, Receipt No. Z� ?
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Date �/� f By �i
Buildin¢ Ofticial Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 �-�1