HomeMy WebLinkAboutPlumbing Permit #12-1402 � ❑ ❑ � n 00❑000 � O A =A
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CITY OF PRIOR LAKE PLUMBING PERMIT
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( � (Phone) � J���'7(J'`75�(�
(Address)
APPLICANT
(Name) C�rt�$ ��' (Phone)
(Address) 1 � �+155379
(Address � (City) (Zip Code)
(Contact Person) (Phone)
APPLTCANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Figture uanti T e of Fixture
Bath Tub with or without shower Rou 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, Commeroial & Multi-family i% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residenrial, Additions & Alterations $49.50
The Minnesota Statutes § 32bB.148 �ost $ Building Permit #
" SURCHARGE " has been extended pLUMBING PERMIT FEE $ �_
until June 30, 2013, STATE SURCHARGE $ .hff
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
_ _-
This Application Becomes Your Building Permit When Approved Paid�, `�..� Receipt No. ry/ p�
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BuildfnsOtticisl Da�e Date 1 r���J By �
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24 6our notice forall inspections (952) 447-9850, fa% (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 553T2
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