HomeMy WebLinkAboutPlumbing Permit 12. 0896 — 0 0 NTIL n 000000 7 0> /0
cn ' 0 0 0 c § Z c n O 0 0 m 0 m 0
§> 0 2 2 2 c �� c Ek 2 m X§ q k
t7 r 9 0 0 m z �k*oz 0 0 - - a
m r n n > 2 7 § ® .1 � z -
KZ R *> j z 0
o 0 ° ) z 4 0 /
o z w
\ 0 F. z k C)
a -n 'V I \`-) z q § § 000000
x » § ] , $� �t��
2 % ° ° ? &Km ?3 - 0 m
\ \ m ƒ \ >0 00� 0 E 0 \ m
0
. `a \ 0 r�99 r
§ P. § �k P m
\ ■ (
= m g 2 0
m m , )400000 L 4
§ z $ ]I§§ s
�MM30 J. m
/ k� /�0 Vi
q z a 2�E¥
) n mom r a
m 22— m
0).
E
PRID Date Rec'd
H
e CITY OF PRIOR LAKE PLUMBING PERMIT
4 "-INNEso ''
I. Blue File PERMIT NO .
z. old City /2_ —o esi 9 l
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS uebird ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` /�
(Name) _L . � �1 L11 A • _) (Phone) _ / ,� 't I L�
(Address)
APPLICANT Champion Plumbing
(Name) PC 000308 (Phone)
(Address) 651 - 365 -1340
(Address) 3670 Dodd Hoad (City) (Zip Code)
Eagan, MN 55123
(Contact Person) �--� (Phone)
APPLICANT SIGNATURE 3 1 47 ) L i DATE �I l
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower .._..e1.
Dishwasher
Floor Drain • - -
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 Est $ C:31 Building Permit #
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until June 30, 2013, STATE SURCHARGE $ ,, .50
The minimum surcharge for a TOTAL PERMIT FEE $ c t
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid$j1 Receipt No.
Buildinn Official Date Date g / / y _ By
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372