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° " Vire CITY OF PRIOR LAKE PLUMBING PERMIT
41I1` 'CP
I. Bolt Fat Applicant PERMIT NO .
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(Please type or print and sign at bottom)
ADDRESS / �! L /J ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
(Name) ANT Weld & Sons Plumbin
3410 Kilmer Lane North (Phone)
(Address) Plymouth, MN 55441
(Address) 763- 475 -0296 (City) (Zip Code)
(Contact Person) % /1) A ✓` (Phone) 76- ' 7- 0 2-9
APPLICANT SIGNATURE �� 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 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 $4950
The Minnesota Statutes 5 326B.148 Est $ Building Permit if
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $
is ,f,, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid // , ` Receipt No. 9/ 72
Buildins Official Date Date /� ��3 B y e
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372