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O Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
4 /Z. to-13
': a'' �'` PERMIT NO.
3 . ne AY rL -� z 7
3. Yellow Applicant
(Please type or print and sign at bottom)
_Meese
ZONING (office use)
16058 Jordan Ave. SE Prior Lake, MN 55372
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) SHAWN & ANG FUMANTI (phone) 651 -485 -8201
(Address) 16058 Jordan Ave. SE Prior Lake, MN 55372
APPLICANT
(Name) DANA HOAGLAND PLUMBING INC (Phone) 952 - 935 -5150
(Address) 410 REGENCY LANE W HOPKINS MN 55343 -3417
(Address) (City) (Zip Code)
(Contact Person) JAKE BARKEI (Phone) 612- 802 -2137
APPLICANT SIGNATURE ' - -=� . ../ DATE 9/21/2012
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
1 Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
1 Shower Stall Backflow Assembly
1 Sinks Laundry Backflow Assembly Test
Bar Sink Lawn Sprinkler
1 Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family l% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations .5E1
,
The Minnesota Statutes § 3268.148
— ist $ Building Permit # je
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 49.50
July i, 2010. until June 30, 2011. STATE SURCHARGE $ .50 �.
The minimum surcharge fora "fired fee" permit TOTAL PERMIT FEE $ 50.00 $
Is N beginning July 1, 20]0
This Application Becomes Your Building Permit When Approved Paid Receipt No.
'� Dc? > 7c.3 7
Date if / /1„, By
BaildisQ Official Date <_(0
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 1 30
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ) g 00
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