HomeMy WebLinkAboutPlumbing Permit 14. 0365 O J
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04 PRI0� Date Rec'd
0H CITY OF PRIOR LAKE PLUMBING PERMIT `$ 1"
(
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t. GPERMIT NO./V.-2. Goldold City 3 6 S
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
..--,6, 73 4'.e-eiC x% c__Er
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT
(Name) Zo ' S L- c Vd:-S (Phone)
(Address) g-4'Z— 1/L Lf /vat/ ,e>-_-_--
(Address) (City) (Zip Code)
(Contact Person) .43 UA' -S ' L (Phone) (z" " 6 , . /-,S
APPLICANT SIGNATURE P-0-1-4^r4416----- DATE c--1.5-"--
APPLICANT
i.5-"--
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 X 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
The Minnesota Statutes§3268.1413 Residential,Additions&Alterations $49.50
"SURCHARGE"has been extended it $ Building Permit#
The minimum surcharge for a
"fixed fee"permit is$5.00 PLUMBING PERMIT FEE $
STATE SURCHARGE $ ______,Iftb .50
.. ,. . . - TOTAL PERMIT FEE $ '7
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid s--q0 Recei No. /( .(„ 0
Date ./ By
Buildine Official Date L . (S I
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372