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( /p, Date Rec'd
e CITY OF PRIOR LAKE PLUMBING PERMIT
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• , 2 Blue File PERMIT NO.
Gold City ,
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ��� Cl 1 v �� `�/WC V1 (Phone) Q'l(jd) H4 �'
(Address) 111 Li 0 SUO v�C
APPLICANT
(Name) (Phone)
Appliance Connections Inc
(Address) 1313 Danita Cr
1iafCsSpee, MN 55379 (City) (Zip Code)
(Contact Person) 9 2- 445 -4803 , (Phone) q
APPLICANT SIGNATURE Ill/ t , 1 a . DATE I - `' °O ' - I' - I '
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, . PLICANT 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
New Fees Effective January 8, 2008
Industrial, Commercial & Multi-family 1% 01 Commercial Plmbg. /Mech. 1% of job cost, $50.00 min tial, New One & Two - Family $99.50
Y Commercial Sewer /Water 1% of job cost, $52.00 min. tial, Additions & Alterations gig Residential Sewer /Water $51.50 + .50 = $52.00
New Residential Plmbg/Htg. $149.50 + .50 = $150.00
Estimated Cost Residential Add /Alt. Plmbg/Htg. $49.50 + .50 = $50.00
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
4 This Application Becomes Your Building Permit When Approved Paid 4,..q ` Re e t No. ( 4e Building Official Date Date I • c _ B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245
/ 42 � 45
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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