HomeMy WebLinkAboutPlumbing Permit 12. 0031 J
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C IVES RIo Date Recd � CITY OF PRIOR LAKE PLUMBING PERMIT
Neil Flood
17451 Sunset Trail Southwest
P Prior Lake, MN 55372
O� 9522266942 . Slue File
. Gold City � PERMIT NO. / � 3
. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 7 ' 4 . S r Su .s-et Sv✓
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) ER ' e C t, Pt 00 d (Phone) (q52-) 2-P ' (,94
2'
(Address) 1 ` I✓ I SunsC Tra,c L S
APPLICANT
(Name) NORBLOM PLUMBING CO. (Phone)
(Address) (612) 827 -4033
(Ad '5 GARFIELD AVE. SO. (City) (Zip Code)
(ContactPerson� MINNEAPOLIS, MN 55408 (Phone) at(2-) n-/ .1. -tb✓
APPLICANT SIGNATURE ?JZ-i
_ DATE I' 1 1 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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
M ost $ g190 . Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $ ify, ce
year effective STATE SURCHARGE $ c 5�
July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ 51-.
is 55, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid ,.. 5-V s ---0 Rec/No. & c fc,a
Date / " I � By
Buildine Official Date B •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372