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HomeMy WebLinkAboutPlumbing Permit 11. 0503 5 0 0 o 00000O - 0 o» E n n o . 0 ■z $kc 0 m m0 >c o k k 0 § . M 2 CO - -a t § 0 Z k K > 1,-, . © z o 2 § ; ■ . � k f > 0 mm % 2 1 . . r o / 1 I z XI 2 7 R R 000000 1 m q mm 4 � a7 ■er Q z o g nc2�nc C E ? -0 z m ■ -0 0 ( ■ § 2 2 \ , >0000 m m q§ 0 t r222 m= o c 01 2 4 m . �, > c c 13 § b / z xi • 2 c m 0 13 m . OCOOO ) r • z a ��n§ . r > % � 1:in § §�© A / g 0 I . 0 k >MM q p , ■ te a P 2 k/ 0 m o , p Ri Date Rec'd e CITY OF PRIOR LAKE PLUMBING PERMIT N exi rNNEsoo I. Blue File PERMIT NO . O 2. Yell App licant / ` �j 3. Yellow App �./ (Please type or print and sign at bottom) ADDRESS •-•—•••••" ZONING (office use) ill Eau it 6 wail I ICE_ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID �/ (� (Name) r OWNER � % � � ' � / � w (Phone) 5 � — 1 ( 7I3Y7 (Address) 6 tMIY ThDC 1,(A N i 5 53 7)1 APPLICANT Champion Plumbing (Name) # 61770 - (Phone) 651 - 365 -1340 (Address) 3670 Dodd Rd. drf, 55123 (City) (Zip Code) (Contact Person) S (Phone) APPLICANT SIGNATURE ° �. DATE — r f Of 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 Est $ Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ q 'SD July 1, 2010, until June 30, 2011. STATE SURCHARGE $ i The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ is Ls beginning July 1, 2010 ` � This Application Becomes Your Building Permit When Approved Paid S 11 v R- . No.f 3l/ t Date /e � ✓ / / f Building Official Date C! !/ 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 ) 03V 4646 Dakota Street S.E., Prior Lake, Minnesota 55372