HomeMy WebLinkAboutPlumbing Permit 13. 0734 ( ❑ 0000 2 O C N
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1 i'lli Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I Soo (. Blue File PERMIT NO.
2. acrd cla /j 73 T
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
J 6 L/ J S A crk7 Ati /
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER - O �S h b A nA I SI/ n (Phone) 6 J 2 � J9 1,7,
(Name) 7 { / p
(Address) ) ( 9 3 Set? A% / MA) , Si- h-/CD
(Name) T J a_ ! C (A/0Q_ (Pi till 1)1j 21f — .r-1-7--,./4-0
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(Address) 3 .- ' Atit, Mt) ,l ip .. VP? 1/4SSJ-Q
(Address) (City) (Zip Code)
(Contact Person) J e IV HArtra E (Phone) c - 9.z d 0 3' - ,5-
APPLICANT SIGNATURE DATE 9 - 2 - ) V
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 r 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 it 326B.148 Est $ Building Permit #
"SURCHARGE" been changed for one
year e ffective PLUMBING PERMIT FEE $ Y 1-
ye effective
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ 3'7, 0
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ fy 1
Is beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid sy s o Receipt No. 9 / i j
Date 7/! �3 By
13mi3diYS Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372