HomeMy WebLinkAboutPlumbing Permit 13. 1082 J
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Date Rec'd
° z .r: CITY OF PRIOR LAKE PLUMBING PERMIT
V
iNNES0
1. lilac F PER NO. 3 /0
2. Oold C ity / O p
3 . Yellow App licant
(Please type or print and sign at bottom)
ADDRESS
27 L18 COUL9 ZO NING (o(office use)
&Ur 1 1
LEGAL DESCRIPTION (office use only) 41/10(5
LOT ' 3 B L O C K ` � ` • ADDITION 00 „ PID q 5 : " 4/107-- 9 5 — 0
OWNER
?f � ° C l� C o l ryl �� ,/1 (Phone) 1 Sz C/ C/ S- 8 1515 V
(Address) 2 / L/ ( 8 (.o u1 or Path NI LO Prior Lake,
APPLICANT �1 (� c '] �7 / ('�
(Name) ? I t L� n (Phone) l S I (/ / V 0\ J
(Address) 2200 W l \/ `) Ski-m 1I.1.�� SS3
N (Address) [/ (City) c (Zip Code)
(Contact Person) I •�l- I� (� (Phone) - l J �" (Q -7- 1000
APPLICANT SIGNATURE 1 0" , , I DATE 9 ZS/ I 3
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
FIoor 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 I% of job cost with a $49.50 minimum Residential, New One & Two- Family 50
Residential, Additions & Alterations .50
The Minnesota Statutes § 326B.148 ^ $ Building Permit #
"SURCHARGE" has been changed for one r ! p
year efl'ectiye PLUMBING PERMIT FEE $ `T
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ 5.00 .50
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ sqq . so
1s,, beginning July 1, 2010
This Application : •cor lYt r Building Permit When Approved s- Receipt No. Q ( 0 (7
g I
Date
Buildin - dal Hate �{ 27 1
tI �"�'�
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372