HomeMy WebLinkAboutPlumbing Permit #12-0940 S O O� (� ❑�❑�O❑ � O D ZA
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CITY OF PRIOR LAKE PLUMBING PERMIT
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�'�S �. B�Ue File PERMIT NO.
2. 6old City � � .�. �
3. Yellow Applicant
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ADDRESS ZONIl�TG �omce �>
�353 /2��:1�v'�- S'T,
LEGAL DESCRIPTION (affice use only)
LOT BLOCK ADDITION PID
ame �Utu��OD /�� rn� Z37. d � �
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(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Conta.ct Person (Phone)
APPLICANT SIGNATURE DATE / V 1
PPLICANT PLEASE COMPLETE BELOW
uanti T e of Figture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Flaor Dtain Water Softener
Lavato athroorn 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
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 $49.50
The Minnesota Statutes § 326B.148 t$ Building Permit #
"SURCHARGE" has been extended
until june 30, 2013, PLUMBING PERMIT FEE $ � 1-�
The minimum surcharge for a STATE SURCHARGE $ ���
"fixed fee" perrnit is $5.00 TOTAL PERMIT FEE $ ,�
This Application Becomes Your Building Permit When Approved Paid �-� � Rece' t No. �� .�p�
7
Date� ,�� . � L By
Buildins Ofticial _Date _ _ _ . _ _. �
24 haur notice for �11 inapections (952) 447-9850, fax (952) 447-4245
4646 Dakots Street S.E., Prior Lake, Mianesota 55372
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