HomeMy WebLinkAboutPlumbing Permit #12-1243 y ❑ � C� ❑O��o❑ O � o y�
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� � CITY OF PRIOR LAKE PLUMBING PERMIT
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`. B�°e F"e pERMIT NO. � Z
2. cota c�ry
3. Yellow Applicant
lease or ' t and si at bottom
ADDRESS ZONING (office use)
Ilvq `
LEi GAL DESCRiPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
OWrTER ' P i' f�,f
(Name) \ `'' (Phone) � � �� �� v /
(Address) � � 1�1 C ✓ / � �
APPLICANT �;�a�pion Plumbing
(Name) (Phone)
(Addxess) �5 i -365-1340
�Aa��b Dodd Road (City) (Zip Code)
(Contact Person) Esgart, M N 55123 (Phone)
APPLICANT SIGNATURE '�" DATE IC7 � � �
APPLICANT PLEASE COMPLETE BELOW
Quanti 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 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, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
- . __Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148 °C rjQ
" SURCHARGE " has been extended PLiJMBING PERMIT FEE $ �
until ]une 30, 2013, STATE SURCHARGE $ p� .56�
� The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
'1'his Application gec�e� Your�niding Permit When Approved Paid `� J v e ipt Nc� �3 c�
✓
Date `� , � Q r � � By
Buildine Ofticial Date � �
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 C�
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