HomeMy WebLinkAboutPlumbing Permit 12. 0887 �t
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plr. \ Date Rec'd
4,0 CITY OF PRIOR LAKE PLUMBING PERMIT
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I�'NI S 1 1. Blue File
2. Gold c i t y PERMIT NO. /L Orn
3. Yellow Applicant
lease type or print and sign at bottom)
ADDRESS ZONING (office use)
ILI PGA s;de_ C4 N\J 5S3 7 a
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �(� (�
(Name) J Q r& . D Ce-- (Phone) q5c - as 6- s g 1 y
(Address)
APP CULLIG W ATER CONDITIONINt�
(Name) (Phone)
6030 CULLIGAN WAY
(Address) MINNETONKA. MN 55345
0254s933 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE A11_104 DATE - cl L - 1
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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 1 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
Tost $ 15 L i l , 0 Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ 49.50
until June 30, 2013, STATE SURCHARGE $ 503 03 -�8
The minimum surcharge for TOTAL PERMIT FEE $ „$4 -50
0
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid j—I t Receipt No. j Date v 2 )
By
Building Official Date b h /� L
(7 _-)---___
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372