HomeMy WebLinkAboutBuilding Permit 11.778 Plumbing 1 , - , -- v RI Date Rec'd
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CITY OF PRIOR LAKE PLUMBING PERMIT S /6 / /
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1. Blue File
2. Gold City /1.775
PERMIT NO
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3. Yellow Applicant
(Please type or print and sign at bottom)
0— ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
4 . OWNER jo
(Name) I // MI NN JW4 L/6 (Phone)
(Address) 965 /Ec/i97tj, ,!/F do 40/) 1/111kq /WV L$ W
A: APPLICANT L
(Name) SUmN1 / f F 4 // 75/ p[ /\ / f G #I/t) (Phone) 763' (' 80 y0
(Address) %V/ / Av( N &o /IOW VA / /e ssya 7
(Address) (City) • / (Zip Code)
(Contact Person) • • rr I� ;
1, (Phone) pow -o2w� - 74rO
APPLICANT SIGNATURE . DATE f-4-11 or
APPLICA T PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
,...- Bath Tub with or without shower Rough -ins
/ Dishwasher a. Water Heater
1i Floor Drain 0 / Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Y Sinks 0 Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) / Other g E/ s1 1*) TrACAVUL
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ A QOO OG Building Permit #
The Minnesota Statutes § 326B.148 b
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ S:0 0 et
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ Ar o0
The minimum surcharge for . "fixed fee" permit
is $5, beginning J 1, 2010 ,�
This / a/, Becomes Your Building Permit hen A proved Paid G5 0 0 Rec��j%t No. /3 Q 4Z
/ '14.4 v 7 z // Date , 11
7 •11• I fficia Date �� 1
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24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372