HomeMy WebLinkAboutPlumbing Permit 11. 1191 J
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F rR10 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I NNESO
1 Blue File
Gold d city PERMIT NO. l i i g i
. Gol
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
atjer 5+,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -
-T— T ed G U ii (Phone)C15 2 GG Z.50 _ "JX
(Address) 5 u, j Prior Lake. \y 2
Address
APPLICANT Champion Plumbing
(Name) # 61770 PM (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
Agiliggril MN 55123 (City) (Zip Code)
(Contact Person) _ (Phone)
APPLICANT SIGNATURE i' DATE 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
The Minnesota Statutes § 326B.148 ost $ Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, pLUMBING PERMIT FEE $ i50
The minimum surcharge for a STATE SURCHARGE $ "Ine :S0
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid 5'1 ✓ �� Rec t No./ - t t G t u
Date I ' y By
Building Official Date ✓ 1 ✓ (,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 I ° ( "