HomeMy WebLinkAboutPlumbing Permit 13. 0436 SMRIO Date Rec'd
.5„.(` e CITY OF PRIOR LA PLUMBING PERMIT
Q , e l, J. -49Se u/ file"--/--71 �
z. 1. oln` �`le city PERMIT NO. /3 _ U `/3 i
c ola
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
') 2 Q)\0:\ PaSS
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER q52 —gam - �11Q1 ?
(Name) � P \ C
.� 0. � ■ , ` M(�Y1 (Phone)
(Address) - i ° (L PC 1 o-v VoSS OUO
APPLICANT
(Name) \ v�.e S � r chOr \ co.\ (Phone) , Z- l� -ZZr
(Address) y", - J ` .Z�.. Vex �1' Le. CQ1`l�t Y� Cj1 Q ()--4- (Address) (City) (Zip Code)
(Contact Person) .f\ 0 C AbauQ(
PPLICANT SIGNATURE( (Phone) �Q 1 Z --..\ - 2
Z
APPLICANT ! � ial. aw DATE ' \ \ 3
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixt Quantity Typ of Fixture
Bath Tub with or without shower Rough - ins
_ Dishwasher Water Heater
Floor Drain _ t 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 § 32613.148 Mg $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ M - 0
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ -5t .5 0
is ji, beginning July 1, 2010
This Application Becomes Your Building .Permit When Approved Paid Receipt 7
Date / /, J By �����- -_�
Buitdinti Official Date / /,�,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372