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Date Rec'd
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A CITY OF PRIOR LAKE PLUMBING PERMIT
Z.-3 A
4I1NNESo0 I. Blue Pile
2. Gold Cllr PERMIT NO . 13-0 6 Z-
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
tI L CiI s wvl 1 d r a v WJ 56-3-3.2#
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION HD
(Name) WNER ` zr 5YaIr'e, (Phone) ( - 1z _.... ) y).%,... - 3'2l
(Address) 11 SUY110 11 Dr. SW fyi Or LAKI SS 312,
APPLICANT Noah Acquistions. LLC
(Name) dbalieniamin Franklin Plumbing (Phone) (v12:: 5 Z
1424 3rd StN
(Address) Minneapolis. MN 55411
J /&L `e '�U (Address) (City) � " (Zip Code)
K a ,-- vie (Contact Person) ( G�,Ir1 (Phone) t!Z 127 23 C3 9 q '+ V
APPLICANT SIGNATURE , ' , _1 DATE (2/5/1
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 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
Est $ i5 J Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ H C 5
.July 1, 2010, until June 30, 2011. ST7 ------ $i - '�5$ - 5.
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ F 1-1. SD
ism, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid If 5z? Receipt No. 934)e Building Official Date Date / � \ ] By IL
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 - 4
4646 Dakota Street S.E., Prior Lake, Minnesota 55372