HomeMy WebLinkAboutPlumbing Permit 13. 1140 J
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=` CITY OF PRIOR LAKE PLUMBING PERMIT /
1. 61ue File / 4
2. cola city PERMIT NO. ��
3. Yellow Appliceni
(Please type or print and sign at bottom)
ZONING (office use)
ADDRESS ) 5Z 9 1 lox lak‘l,C-1- 1\03 K l
LEGAL DESCRIPTION (office use only) !,, ,j� ,/ f�' �yL
LOT BLOCK 2- ADDITION of el25 9/0/ ` �� !Y Pmo16 ,/ 17 " 0 /Z — 0
OWNER Ir � 9 C� 2
(Name) t, 1 {._ (Phone) 1 Z-" cJ X739
(Address) 15 Lei i FO x la( 1 C+ NI Lc)
APPLICANT l or S2:7(17- j �� rr \\ �
(Name) . Z` & . (Phone) .QL V V V
(Address) 0 ■ A ` ..V S C 5533
N (Ad. ress) (City) �] J �'`� (Zip Code) Cf'
(Contact Person) 1 1� 1 In (Phone) 1 1/ OC 0
APPLICANT SIGNATURE 1� ' , z DATE I D 1 / 2)
l
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher
0 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 l% of job cost with a $49.50 minimum Residential, New One &'i'vo- Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes $ 32613.148 w tst $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
.July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ - 1. 5D
is 5.5, beginning July 1, 2010 '
This Application Becomes Your B ding Permit When Ap Ned �? Receipt Nol V So
Building Oftict at e t) 1 ■ ate U p e 1 ) , 1 � By
6kf ...
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372