HomeMy WebLinkAboutBuilding Permit 12. 0119 R RIO 7' Date Rec'd
:c. CITY OF PRIOR LAKE PLU : T
2 . 11 , 17--
'INNESOL
1. Blue F il e PE NO/
2. Yel C p p Z.,�.1 1
(Please 3. Yellow Applicant
( type or print and sign at bottom)
ADD.' SS
/ 44 0 i �� , 1 .- ZONING (office use)
1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER c
(Name) � -e Phone /° r 0 (Phone) Ci�C. //
(Address) / VI nA ft,
APPLICANT Appliance Connections Inc
(Name) 1313 Dd l l l to Cr (Phone)
(Address) Shakopee, MN 55379
(A , 5_4
03 (City) (Zip Code)
(Contact Person _,k al - j� (Phone)
APPLICANT SIGNATU' i � ~ '
, __ _j = DATE r �
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantit Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher
1 Water Heater
Floor Drain 1 Water Softener
Lavato Bathroom Sink) Stand Pi • e Washin • 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 ost $ Building Perm't� #
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ G
until June 30, 2013, STATE SURCHARGE a
The minimum surcharge fora $ e
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 4 ;.
This Application Becomes Your Building Permit When Approved Paid / / 7 Re �- ► No. 7,
Building Official Date Date 7---r 1-2- ;
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372