HomeMy WebLinkAboutBuilding Permit 11.744 Plumbing VRI0 Date Rec'd
,� =y o . CITY OF PRIOR LAKE PLUMBING PERMIT
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41 NNESO *
I. Blue Pile PERMIT NO .
2. Y City ( ���' /[� _
3. Yellow A�+licroni �T, 'T
('lease type or print and sign at bottom)
ADDRESS ZONING (orrice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) F 14 (Phone)
(Address) ,D99, L.) C,4-.1 G C. 4-
APPLICANT
(Name) T h 1 T sl11e 6i" (Phone)
(Address) 0' 9 ' 99 ( -A - ' C'Al (e'k yD ,j�•v, ,As 55 3t ,
(Address) I (City) (Zip Code)
(Contact Person) C 23e_,N �4.■-r y (Phone) C.,2 5 1 C l s s 3
APPLICANT SIGNATURE - ' , 4 / i f DATE S-- T D M
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
_ Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
I Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
1 Sinks Backflow Assembly Test
Bar Sink _ Lawn Sprinkler
1 Water Closet (Toilet) — Other
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
The Minnesota Statutes § 326B.148 Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 4 S'
July i, 2010, until June 30, 2011. STATE SURCHARGE $ .50 O ,C>!
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 5 5
is beginning duly 1, 2010
This A t is . ion Becomes Your Building er t When Approved Paid 4 - Re. No./ _ 3 Si ( 4_,
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`' 1 0 /( Date cr • (0 . (I B
B ■ � 8 Official •
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245 111
4646 Dakota Street S.E., Prior Lake, Minnesota 55372