HomeMy WebLinkAboutPlumbing Permit #13-047 o y ��
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0 4 P Rtp� Date Rec d
,� CITY OF PRIOR LAKE PLUMBING PERMIT
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�� t. Blue File
2. Gold �� PERMIT NO. �� _ U 7
3. Yellow Applicant
lease or ' t and si at bottom
ADDRESS ZONING �o��,�>
� �}5 Lo� �r � � C;r�,\� S E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /,,� Q r,, '`
(Name) � l l��_ � I S � (Phone) U!� �� 3�S U l� U/� `1"
(Address) -�j�'J L �' I�fUY1 �J►'r 1 �1 MK1 �"
APPLICA.NT ' f1 '�,�P,n C�anK-1�r� \r
(Name) 1 V h��.�,� �� �"1 �5 (Phone) �S? 1 a - �c�-� ` �
(Address) � C�� �'�^'" � � , M��� I "�Y � ��J�' 1 �
(Address) —` (City) (Zip Code)
(Contact Person) ��}� c��� 1 1 '� ' (Phone) �� � -� aa - saa �
APPLICANT SIGNATURE ` DATE I � I�
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 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
Industria(, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 t$ �.�.�_ Building Permit #
"SURCHARGE" has been extended
until june 30, 2013, PLUMBING PERMIT FEE $ y�. �J�
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ �'� . �(�
This Application Becomes Your Building Permit When Approved Paid ��� Receipt No. �� n ��/
� ��J 0
Date ` j 1 BY
Buildin¢ OfFicial Date /
24 6our notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Mianesota 55372