HomeMy WebLinkAboutPlumbing Permit #12-1437 \ �
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CITY OF PRIOR LAKE PLUMBING PERMIT
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�� I. Blue File PERMIT NO .
2. Gold Ciry � /Z�/��
3. Yellow Applicant
88SC OT � t 811a � St IfOttOnt
ADDRE S ZONIlVG �otr� ��
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LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER ' 7 �� � �
(Name) (Phone) ��,�
(Address) � �
APPLICANT
(Name} (Phone)
(Aaaress) 12850 Chestnut B�vd.
(Address} ������°� (City) (Zip Code)
(Contact Person) �Phone)
� �
APPLICANT SIGNATURE DATE � �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom 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-fatnily 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residenrial, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 vost $ Building Permit #
" SURCHARGE " has been extended pLUMBING PERMIT FEE $ �
until June 30, 2013, ' '
The minimum surcharge for a STATE SURCHARGE $ -f�
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $��
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This Application Becomes Your Building Permit When Approved Paid � � j�� Receipt Na� �
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Date f � /�� By
BnIIdins Ofticial Date � ' •
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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