HomeMy WebLinkAboutPlumbing Permit 13. 0886 Y R1/A/ Date Rec'd
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ADDRESS Q ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1 i (Name) p l\ Ok) (Phone) 2 l c� l� St a - 36
(Address) 2904 K kb ` 1 r t ay N -j-
APPLIC a � � C k �(�� 1 c
(Name) -P & k U (6 S y ' ` Phone) 6 b Z-^ 756 — Z2 55
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(Address) _ ///:/../r \ ' 5
(Address (City) (Zip Code)
(Contact Person) b . i l 9 a" ( (Phone)
APPLICANT SIGNAT ' ■ i , g A i,, ,;r , 1 DATE Al 1-- APPLICANT PLEASE COMPLETE BELOW
1.
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
_ Dishwasher Water Heater
Floor Drain 1 Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 com artment sink Sew ge 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 § 326E3.148 - MA $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ 3 L ; a
July i, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The f u r fee" permit TOTAL PERMIT FEE $ 'j , SO
is is beginning July 1, 2010
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This Application Becomes Your Building Permit When Approved Paid 6 - ; / ` Recei o. & Date - ` / 3 By
Building Official Date U 4
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372