HomeMy WebLinkAboutPlumbing Permit #12-1308 y ❑ O� n ❑O�ODO O � v Z�
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�,. :,:� CITY OF PRIOR LAKE PLUMBING PERNIIT
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'. B�"` Fa° pERMIT NO. /y � D�/
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3. Yellow ApplKanl
leaae o or int and ai n at bottom)
ADDRESS ZONING (ottice �se)
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LEGAL DESCRIPTION {oH'ice use only}
LOT BLOCK ADDITION pID
OWNER
{Name) (Phone)
�
{Address)
APPLICANT �� 1 r' -7 J,
(Name) �� S' � a tr (Phone) /�P 3 7 98' ��S 7
(Address) � t�o S ( i o n-e�z r r L D ��e. T I�+ .SS 3 S?
(Addxess) {City) (Zip Code)
(Contact Person) r � � {Phone) _�0/r� 3�0� S�B�o
APPLICANT S�GNATURL� DATE U l g l
APPLIC.ANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floar Drain Water Softener
La.vato Bafhroom Sink Stand Pi e ashin Machine
Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backtlaw Assennbl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commerciai & Multi-family 1% of job cost with a$49.50 minimum Residendal, New One & TwaFamily $149.SQ
Residen#ial, Additions & Alterations $49.50
"fhe Minnesota Statutes ¢ 325F3.14R � �st $ _ $uiiding Permit #
"SC has been chats�ed For otte
ycac elfective PLUMBING PERMIT FEE $
.►s,ty° �. 20�0 ant6i 3une 30 �ol �. STATE SUR.CHARGE $ .50
The minimum surcharge fpr a "Pxed fee" �ermit TOTAL PERMIT FEE $
is ,S�,.i, Ucginnin� July 1.. 2010
ThisApplication Becomes Your Building Permit When Approved Paic' ••; �' /� Receipt No.� ,�� �//
.ri � d
Date �� i� By
Baildlne Offlcial Date � 7
24 haur notice for all inspections (952) 4d7-9850, fax (952) 447-4?A5
4646 Dakota Street S.E., Prior Lake, M�nnesota 55372