HomeMy WebLinkAboutPlumbing Permit #12-1129 N O❑� C� ❑OD❑❑❑ = O o Nc?
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CITY OF PRIOR LAKE PLUMBING PERMIT
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V
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�. B '°` ���e PERMIT NO. �L —! I �
2. Gold City
1. Yellow A�rlicant
lease or rint and si at bottom
ADDRESS ZONIlVG �o�ce �)
I s3s �,���-,.�5 ;� R �s3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � or� nG C�•�� e.v� (Phone} �5 I- 3 3 �- 9510.3
(Address)
APPLICANT
(Name) CU�_t �rAN W�1T��� „ ��n,T��,.�,�,,.� (Phone)
6030 CULLIGAN �!►/AY
(Address) M 1 N N €-T-9��-K , """ � '- �3��
(Ad�s�� 9�3-7200 (City) (Zip Code)
(Conta.ct Person) (Phone)
.
APPLICANT SIGNATURE DATE ' I - I
APPLICANT PLEASE COMPLETE BELUW
Quanti T e of Fixture uanti T e of Figture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato athroom 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, Commerciat & Muiti-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residentiai, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 t$ Building Permit #
" SURCHARGE " has been extended � pLUMBING PERMIT FEE $ y q. SU
until June 30, 2013, gTATE SURCHARGE $ , 0� -
The minimum surcharge for a
"fixed fee° permit is $5.(�0 TOTAL PERMIT FEE $ s y� S l�
This Application Becomes Your Building Permit When Approved Paid ���-� Receipt No. 7 �� Q
7
Date p� //� By
Bnildin¢ OtT�ciat Date 7 /
24 6our notice for all inspections (952) 447-9850, fag (952) 447-4245
. Ab46 Dakota Street S.E., Prior Lake, Minnesota 55372