HomeMy WebLinkAboutPlumbing Permit 14. 0325 J
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P I Li -19 55
04 VR10,� bate Reed
CITY OF PRIOR LAKE PLUMBING PERMIT •
1K.5
arso'tt'
'•al"` Fc,t PERMIT NO.
Z.Dold aly /i, 7
Yellow Apylicant .4
(Please type or print and sign at bottom)
ADDRESS r �'/.� �� Phka.saini
Ran ZONING(ofrlce use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
- C� C� /
OWNER io -(-.K
r (Phone} J ` ti ~�'ame
(Address) i LI 59 0 (i) c%C\ R A n
APPLIC(Name)ANT I, p l V ... (Phone) CSL l(�- l�1 ��
(Address) ` L 3 i l/U Jit SS
(Address) (City) (Zip Code)
(Contact Person) ti
A'A'' (Phone) SL-7161- 0
APPLICANT SIGNATURE IP
V 1(44 DATE LE! 1 C
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without showerRough-ins
Dishwasher ( Water Heater
Floor Drain Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
T
Sinks _ Backflow Assembly Test
Bar Sink _ Lawn Sprinkler
Water Closet(Toilet) Other
The Minnesota Statutes FEE SCHEDULE
"SURCHARGE" §3261.148 I jot;cost a$49.50 minimum Residential,New One&Two-Family $149.50
has been extended • r Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
•PLUMBING PERMIT FEE $ l ( 'SC)
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ 5L( ..SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid `, �) Receipt No.,r/21�
c
Butldin¢Official Date Date J/) By i If
tf-�'L_--
r-
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 i
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372