HomeMy WebLinkAboutPlumbing Permit 12. 1478 r xr
le'�C l ,�} c; 1? . go z- &uJ 7� - - /3 Date Rec'd
O ban°' h �
A. n CITY OF PRIOR LAKE PLUMBING PERMIT
Z3 V i II
k INNEs o °
1. Blue File
2. cola city PERMIT NO . ;r -
3. Yellow Applicant t /` t t /4
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
,3 (9 3 2 zoo ( e)TE / s x J
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) _. -J In 02 (Phone) 6 l? - 7/0 - /7
(Address) tS/1C-
APPLICANT
(Name) U 1 - Ti/6 6d 1- d j. (Phone) 76 2 - 'S - 7 70/
(Address) y / S O (, c .5 ,s is ✓ICS ,d /06 644-//±6- L 3
(Address) i (City) (Zip Code)
(Contact Person) /. X64 /--/ 4 7v (Phone) ,Z ! r 3-7 S - C)&
APPLICANT SIGNATURE ; _.L/ rA A DATE / / /
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 I 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 § 326 w )st $ 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 fora "fixed fee" permit TOTAL PERMIT FEE $ 5 b
is 35, beginning .1uly l, 2010
This Application Becomes Your Building Permit When Approved Paid i j 3-6, Receipt No. ` , /
Building Official Date Date „ / 1 f2._ By C../
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 rm-W-0