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4, e - , - ;7 , ,r CITY OF PRIOR LAKE PLUMBING PERMIT
�INNEsoo
t. Blue File PERMIT NO. /3 _ f�p
z. Gold city
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
t L\ - c . eqn � � • P 3( kakz, MN 5
e 4
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Na WNER �V�� � V SDI (Phone) ° C2 Lt L15, 8'131
•
(Address) k L 12 0 gvtt <9 . - P'r\ G( look e. , i■N 5s 31
APPLICANT Noah Acquimons. LLC / 1 — C i G �
(Name) dba.Benjamin Franklin Plumbing (Phone) L •
1424 3rd St N
Minneapolis. MN 55411
(Address)
(Address) (City) (Zip Code)
1,
(Contact Person) �-01'C 1Z-1 t&.4(\ (Phone) 2 23 '6' C l R
APPLICANT SIGNATURE DATE _. 1 2 4 1' /
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 2— 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
ist $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 201 I. STATE SURCHARGE $ .50
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $
is SS, beginning .July 1, 2010
This Application Becomes Your Building Permit When Approved Paid Receipt No. ` 9 d;/
Date e Jit .� V By .�
Building Official Date 0 /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372