HomeMy WebLinkAboutPlumbing Permit 11. 0982 r
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4 r RIO Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
P
ik
I4 NEW 1 Blue File /
2. Gold city PERMIT NO. / / 9 g
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
41Ddcl QI eCkSavIk S St, S537a
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1
(Name) 5k eve v 0 S S e v (Phone) Ts a- 9 q ' 9 15 5
(Address)
APPLICANT CULLIGAN WATER CONDITIONING (Phone)
(Name) 6030 CULLIGAN WAY
MINNETONKA, MN 55345
(Address) i (952) (City) (Zip Code)
(Contact Person) , , (Phone)
APPLICANT SIGNATURE 1 t DATE - g-
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 i 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
r ` ' ' " 1st $ D00.00 Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ S 00 -
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ 5 q . 50
The minimum surcharge for a "fixed fee" permit
is 55, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid s , I ceipt /st I t ' wr
Date G lQ _
Building Official Date 1 , Z0 `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372