HomeMy WebLinkAboutPlumbing Permit 10. 0858 3,
0,Rl Date Rec'd
A 4 CITY OF PRIOR LAKE PLUMBING PERMIT
j i,ESOP 1. Blue File
2 G City PERMIT NO. 10 050
3. Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/Ua75 c erfeid br
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / Aft r
(Name) aria / Y t .S . t f� (Phone) (A ,kg'/
(Address) Same, / --- C� It � i\ ` 5 7c
APPLICANT Champion Plumbing
(Name) # G1770 -PM (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
(Adccn, MN 55123 (City) (Zip Code)
(Contact Person) -Kris 0 (Phone)
APPLICANT SIGNATURE DATE ___9_,q19-10
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
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
PLUMBING PERMIT FEE $ I l q • 5 p "SURCHARGE" has been changed for one
STATE SURCHARGE $ S .. vow year effective
TOTAL PERMIT FEE $ $ � ' � July 1, 2010, until June 30, 2011.
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(Office Use Only) ++ The minimum surcharge for a "fixed fee" permi
i is 55, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid / ,---1 Rec 'pt No. / / � i
�
Date O . / 6 e
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 73)5
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