HomeMy WebLinkAboutPlumbing Permit #13-0009 �'n ��� C� OOO�OO � O D ZA
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F CITY OF PRIOR LAKE PLUMBING PERMIT
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�. B�ue File pE�IT NO
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3. Yeliow Applicant � J
lease or ' t and si at bottom
ADDRESS
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LEGAL DESCR,IPTION (oflFce use o y)
LOT BLOCK ADDITION p
OWNER
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(Address)
A.PPLICANT
(Name) (Phone)�L�¢ ��� �.-�T_.,L_
(Address) �� IflC.
(Ad � � �N 55379 �ci�'� (Zip Code)
(Conta.ct Person) �e, �5'��� (Phone)
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APPLICANT SIGNA DATE � I
APPLICANT PLEASE COMPLETE BELOW
uanti 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 Bathroorn 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 & Multi-family 1% of job cost with a$49.50 minimum Residenrial, New One & Two-Famity $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGF. " has been extended pL,�B�G PERMIT FEE $ ,�
iantil Jun� 30, 2013, STATE SURCHARGE $ .��_{�
The minimum surcharge for a TOTAL PERMIT FEE $ �
"fixed fee" permit is $5.00
i lilA t��►�/iR;tlldVL DCCUIIIE.'S x uur �sunding Permit When Approved Paid �� Receipt No.� ��
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Date �� //� gy �.�-
Buildin¢ Ofticial Date ���„_��
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesots 55372
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