HomeMy WebLinkAboutPlumbing Permit 11. 0247 0 0 0 ' 0 > 20
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4P ' � � ITY OF PRIOR LAKE PLUMBING PERMIT X33 //
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INNESd 1. Blue File
2. Gold city PERMIT NO.// 2 _47
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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7 I
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ZO - �L
(Name) C ps � /g^C (Phone) �Z - Z
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(Address) /0 /5 l ty �
Z4— /0 ,
APPLICANT
(Name) �<`L �'k'4 ��//+ 7� ( P hone)
‘/,-, C�- 51 Z
(Address) / % f U 4 /i/ 11/%ln4/q % Ze.A 5 a - V/(
(Address) (City) (Zip Code)
(Contact Person) 615 Cttd, (Phone)
APPLICANT SIGNATURE �,girri:, DATE
LICANT PLEASE COMPLETE BELOW
Quantity ype of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher / 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
�j Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 st $ �/ Building Permit #
"SURCHARGE" has been changed for one 0 .
year effective PLUMBING PERMIT FEE $ T 7
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ s"'
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $
is .$1, beginning July 1, 2010 SrP
This Application Becomes Your Building Permit When Approved Paid$_* £ Rece t No6 2,53
Dat /3 /1 / B
Buildin¢ Official Date + ! i ( i
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372