HomeMy WebLinkAboutPlumbing Permit 13. 0919 y. Z n
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4 CITY OF PRIOR LAKE PLUMBING PERMIT
4 4'NESO*
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3. Yellow Applicant
(Please type or print and sign at botttom)
ADDRESS
i )Lfl15 GI (cdk ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( O Na WNER ww J P(-1-eAr l (Phone) l SZ- L N ^ ( V C. /
(Address) I Li T1 _ : 1 . 5
APPLICANT 6 ��2 9s2, -1 O \1 O
(Name) (Phone)
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(Address) Z-2-0 HLu\ / 1 J b ' �l S Y i j l c S'S331
(Address) (City) (Zip Code)
(Contact Person) 1 ��/ (Phone) ( J C. I lX ( �.J
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APPLICANT SIGNATURE OII (i DATE 5 2.
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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
Residential, Additions & Alteration $4.50
The Minnesota Statutes * 32613.148 w Est $ Building Permit #
"SURCHARGE" has been changed for one � d9 SO
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year elTective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 5 y .50
is , beginning duly 1, 2010
This Application Becomes Your Building Permit When Approved Paid �'i / 3 - 0 Receipt No. fg 'T
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Date #2,2....h J 3 By ‘�
Building Official Date L �--1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372