HomeMy WebLinkAboutPlumbing Permit 13. 0171 O J F
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PR10,, Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
v File
I.
2. Gold City Cit p PERMIT NO.
_ /� 7/
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14 H D a Parks, G n .SS3 7
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER yY
(Name) Ni,v 1 €- /Ca (Phone) - 7 a 0 - 'I `I 7 7
(Address) I'0 0 a; Pc \ lk C n
APPLICANT .MULLIGAN WAFER LONDITIONING
(Name) 6030 CULLIGAN WAY (Phone)
MINNETONKA, MN 55345
(Address) (Addrs 933 -7200 (City) (Zip Code)
(Contact Person) \ (Phone)
APPLICANT SIGNATURE r� t/ DATE a ` 1 V
I
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 ( 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 $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 $ )5 Sq . 0 0 Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, PLUMBING PERMIT FEE $ L i S • SO
The minimum surcharge for a STATE SURCHARGE $ S 00
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 5' f 5 Q
This Application Becomes Your Building Permit When Approved Paid 44 Receipt No. j i U
Date �� / 4 f z By l 0
Buntline Official Date '� / '7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372