HomeMy WebLinkAboutPlumbing Permit 13. 142 J
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pRr Date Rec'd
e CITY OF PRIOR LAKE PLUMBING PERMIT
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411NNEsOt" 1. Blue File
2. Gold Cit PERMIT NO. / 3 , / 9 Z
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
i 61 .73 j bt)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) OWNER •
/ . ; /' (Phone) + '1d 7 — / 7423
(Address) 541 rn
APPLICANT Appliance Connections Inc.
(Name) 12850 Chestnut Blvd. (Phone)
Shakopee MN 55379
(Address) 952-445-4803
(Address) (City) (Zip Code)
(Contact Person) J 1 l 1 (Phone) LI)13
APPLICANT SIGNATURE . /,II v _' 1 �� � DATE 0
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher t Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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 st $ Building Permit #
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ . 1111
The minimum surcharge for a "
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid -5 3—V Receipt No. 4 (// ry
Date q / � By
Building Official Date ./
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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