HomeMy WebLinkAboutPlumbing Permit 12. 1128 ?RIO Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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INNESol 1. Blue File 12_--1
mid c ry PERMIT NO.
3 Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRESS n r ZONING (office use)
Z G J 2 o kh ts 1I I >_ Dr. N
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PE)
(Name) ) � � h7 k 0 rn s c d- (Phone)
(Address) 212.o kh� j�(d e pr. NW �rlbr l - al�C Nl l� 55 372-
APPLICANT
(Name) U 4 o - - (Phone) 1 SZ — 153 _ ( - /. : L}3
(Address) 174 e `f , e' o c4 / 1 41-74-) e-- M N1 &S 4-1
(Address) n (City) (Zip Code)
(Contact Person) 0 Le ' e c l � - (Phone) 9 S Z--- ef$ 3 - (.14„,,4 3
APPLICANT SIGNATURE y L. p , _ DATE 9 0 —
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 1 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 at $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ ±11 5 G •
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ ,j. O () .756
The minimum surcharge fora "fixed fee" permit
• TOTAL PERMIT FEE $ _631,6-6
is S,5, beginning July 1, 2410
This Application Becomes Your Building Permit When Approved Paid Receipt No. ) 7 (�
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Date 9/2 By 14
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Baildhtu Official Date //
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372