HomeMy WebLinkAboutPlumbing Permit #122-0906 S ❑ — C� ❑OC]O�❑ � O > Zn
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CITY OF PRIOR LAKE PLUMBING PERMIT
V
��r$so'��' (,� � � 67
I. Blue File pERMIT NO .
2. Gold City / L .- ��y�
3. Yellow Applicant __
lease or ' t and si at bottom
ADDRESS ZONIlVG �ot��,�>
I i��3 �uh�rn �-�rt1� C� ��
LEGAL DESCRIPTION (oflFce use onty)
LOT BLOCK .ADDITION PID
OWNE ���
(Name)� 1 �� �T�,� ��.1f l (Phone) �' 39ca-a �r a.r
(Address) 1 y 1�� � , r1 '�1 � C� 1� �r r or �c�+�Ce ��53 � �
APPLICAN �-}�, �*� 1 � � qp
(Name) On' ( Q �(e � �n���� �1 ..L�.' , (Phone) � LJO( � `1�1� - ""1 D W
(Address) I � � � �� I�G ��rC�'e �,),��� `� i � ----
(Address) (City) (Zip Code)
(Contact Person) �.•� 1 � � 1 (Phone)
. �
APPLICANT SIGNATURE DATE I��� I�
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture u�nti T e of Fixture
Bath Tub with or without shower Rau 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
FEE SCHEDULE
Industrial, Commercial & Multi-family i% of job cost with a$49.50 minimum Residential, New One 8c Two-Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 5t $ Building Permit #
" SURCHARGE " has been extended pLUMBING PERMIT FEE $ S� t Q�
until ]une 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 5 ��
This Application Becomes Your Building Permit W6en Approved Paid ���� Receipt No. i ��'
(�
Date p� �� By
Bqild[ne Official Date 0
24 hour notice for all ➢nspectioas (952) 447-9850, fax (952) 447-4245
464b Dakota Street S.E., Prior L$ke, Minnesota 55372
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