HomeMy WebLinkAboutPlumbing Permit 13. 0178 O N
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CITY OF PRIOR LAKE PLUMBING PERMIT
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z. Goad City PERMIT NO. / ' J� /
3. Yellow Applicant ! ci • 1 Y
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
)6 t mcum -v u. Rci NC R , SD
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 46 253. 00 4-- c
OWNER r� _ O R lJl \�{ (P hone) l t J 2' 7 `f �j�
(Address) ( „& A MA __ -1-1-) WE
APPLICANT Appliance Connections Inc
(Name) 12850 Chestnut Blvd. (Phone)
(Address) Shakopee, MN 55379
(Add - 445 -4803 (City) (Zip Code)
(Contact Person) -jQMit '6 • C ' { (Phone)
APPLICANT SIGNATURE , ` .,, s • :' DATE A ` /3
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher I 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
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ .50 /71,73
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
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1 HIS twpi nation nCCUIIICS 1 Mil minding Permit When Approved Paid 54`s_b Receipt loo Q3
Date / B
Buildins Official Date 3 , 1 . !
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 1
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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