HomeMy WebLinkAboutPlumbing Permit 13. 0386 0
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A CITY OF PRIOR LAKE PLUMBING PERMIT
SIN
i. Glue File PERMIT NO .
2. Gold el ow Airy �,
3. Y (r6
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS `` T ZONING (office use)
4-Oet5 Coacl4wt Lava, q.-E. prior La lee
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) I o I ay et Ra.k e-tr � +-� (Phone) (z^ 5 I 36' ' (075
(Address) 44-M3 CO &Ctt La kl,F,
APPLICANT
(Name) Dralin PIO PIuk. blin , .ZtAc. (Phone) R52._ 4-ioci cc( qc
(Address) es( 5 2_.0q4 56 . W . La t-eu l t (e 55 4 4-
(Address) (City) (Zip Code)
(Contact Person) I e'!' Gtr Tr ° t j - / (Phone) 6152- 4 � q ` i
APPLICANT SIGNATURE J • 1 DATE ` ('
APPLICAN ASE 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 I Backflow Assembly F V B
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.S0
The Minnesota Statutes § 326B.148 Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 4/,50
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ 5.60
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 54- 5 0
is 511, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid s4 , l i Receipt No. , grj 2 9
Suildin¢ O
Dates/Dates/03 By ` � b�
Official Date �/
24 hour notice for ail inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372