HomeMy WebLinkAboutPlumbing Permit 12. 0333 a
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Q Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
F City ile PERMIT NO. / 2 333
3. Gold
3. Yellow Applicrem 1
(Please type or print and sign at bottom)
ADDRESS I 5 (c, J ZONING (umee use)
an in no/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �2
(Name) 1. 1 \\ 7 1 (Phone) - y tPS — 42-3
(Address) `5 Y e 1 •
APPLICANT � - $
(Name) Appliance Installers of /IN, inc. (Phone) ,1
141 Rutgers St. NE
(Address) Prior 553 (City) (Zip Ci Zl Code )
(Contact Person) Y 1 e_hP' 1 ∎e_ 1 C) (Phone)
APPLICANT SIGNATURE / • `[ _ L
DATE 14 11 (3 1112-
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 t% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.145
" Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
.iuty 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 5L4 . V30
is i beginning duly 1, 2010
This Application Becomes Your Building Permit When Approved Paid 9 3 -- 0 Receipt No. & s -� y o
Dat 7 B
Baildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372