HomeMy WebLinkAboutPlumbing Permit 13. 1009 J
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PR10 Date Rec'd
0 , CITY OF PRIOR LAKE PLUMBING PERMIT 9F, / c 8
I. Blue PERMIT NO.
2. Gold City y /
3. Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only) �� // 5 /.C)/
LOT / BLOCK .5—ADDITION L 7 // /°it G 4 , s/ AA) , PID W5",? �
? 056 - 0
(Name) 1 -W' " t (Phone) 90 ZZ, 1(24)
(Address)
APPLICANT cif-
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(Name) 1 v l v w'lM / (Phone) - 9 -7- t/ 7iU
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(Address) 6 ”) I (L 1 1 � S 3i ?/
(Address) (City) (Zip Code)
(Contact Person) t,�.. � (Phone) //
APPLICANT SIGNATURE DATE -1 (� --110 .- l 5
A' P C ANT 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 1 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 4 s� Building Permit #
"SURCHARGE" has been extended /q
The minimum surcharge for a ,UMBING PERMIT FEE $ 7` ` s
"fixed fee" permit is $ 5.00 'ATE SURCHARGE $ , J �A
)TAL PERMIT FEE $ 5i/J---)
This Applici io . : eco ; g Your Building Permit When Approved o` 64 _ � s - 0 Receipt No. ,79 ibA
J , c (3 ate `'C 6 r(3 By ra
Buiidin¢ 'd fticial Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 SA--er....*---2
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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