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i VRIO Date Rec'd
,� � , t CITY OF PRIOR LAKE PLUMBING PERMIT
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2 1 Bl d P Ci il t y PERMIT NO. 7
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3. Yellow Applicant .. I
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3077 Lake Haven Court NW
5 F
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID tiC, 3 ( 00(e -
OWNER Dave & Nikki Miller
(Name) (Phone)
(Address) 3077 Lake Haven Court NW, Prior Lake 55372
APPLICANT
(Name) Clearwater Plg & Htg (Phone) 952- 440 -3779
(Address) 19260 Mushtown Road Prior Lake 55372
(Address) (City) (Zip Code)
(Contact Person) Susan Schli (Phone) 952 - 3779
APPLICANT SIGNATURE DATE 2/20/2013
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
1 Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
1 Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
1 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 $ 32613.148 The $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $
ism, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid c{ s Z Receipt o. & g 1 - 2 Z
Building Official Date Date 3 - 7 . 1 By
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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