HomeMy WebLinkAboutPlumbing Permit 13. 1057 N
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CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File pERMIT N O �� -- / y
2. Geld Applicant
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2 . Gel Cpplicant V )
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S (p 6 gaiiiiniter,-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER V
(Name) gruefirk\ (Phone)
(Address)
APPLICANT (� , jJ
(Name) d,b c:I �Z.(1`1 ° CaW (Phone) / - a5 orlri
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(Address) 4 l( . 1 !: `--fr-e , 1, . r ', yo k ld t
(Address) (' ity) (Zip Code)
(Contact Person) igc) L - , (Phone) 6 0- - a)19 Q vQi
APPLICANT SIGNATURE Rd <�� DATE q 1(--
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 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
_ Water Closet (Toilet) Other •
The Minnesota Statutes § 3268.148 FEE SCHEDULE
"SURCHARGE" has been extended f job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The minimum surcharge for a
"fixed fee" permit is $5.00 $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ S (f, ,r17
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid szi y1:) Receipt No. 7
Date q/ By
Building Official Date ' ---
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372