HomeMy WebLinkAboutPlumbing Permit 13. 0940 J
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CITY OF PRIOR LAKE PLUMBING PERMIT tic l
4fjse 1. Blue File PERMIT NO / 9 v
2. Gold City '
p / l
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
81f/tAll
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) P i % (Phone) Yj t )- 3 9a 3 963'
(Address)
(Name) ANT (3 1 ) 11 0 X1df) (Phone) l /..� O // eV9 S
(Address) � V 2 OW ' / - r U C i 7 4 / i " ` 0 r`, s �
//7� (Address) (City) (Zip Code)
(Contact Person) (f..� t) (Phone) 6 a , / J 9 s /
APPLICANT SIGNATURE �4U '' id4A-- DATE
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 f Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compaitment 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 $ Building Permit #
"SURCHARGE" has been extended ►LUMBING PERMIT FEE $ Vq-
The minimum surcharge for a ;TATE SURCHARGE $ .50
"fixed fee" permit is $5.00 COTAL PERMIT FEE $ .5 -
This Application Becomes Your Building Permit When Approved Paid 5 5 -D Rec i No.
Date / LY 3 By
Building Official Date ?l
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372