HomeMy WebLinkAboutPlumbing Permit 14. 0084 • JQ
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04 4RI0� Date Recd
0a CITY OF PRIOR LAKE PLUMBING PERMIT
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2.Got.Blued FilCttey PERMIT NO. /4- e 4
3 Yellow Applicant '
(Please type or print and sign at bottom)
ADDRESS ` ' ZONING(office use)
5L14 vv4 i I\04 oajl I r S �J
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(NWamVe))R 6cra.l c4 / &Vic,t \Gtdcikfv (Phone) q 2-`fqi" -/ 1O
(Address) "T`1 L(I1�V) 'Vje4al -rr. S VV
APPLICANT
(Name) Appliance Connections Inc. (Phone)
12850 Chestnut Blvd.
(Address) Shakopee, MN 55379
(A454803 (Cit') (Zip Code)
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(Contact Person) MI_' 0 (Phone)
APPLICANT SIGNATURE 41 ! it I ' ° DATE 1
/APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher X 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
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&M,tir;_fa.Y+;t. ��of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
The Minnesota Statutes§326B.148 Residential,Additions&Alterations $49.50
"SURCHARGE"has been extended $ Building Permit#
The minimum surcharge for a
"fixed fee"permit is$5.00 PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ i-3-4. 5 o
(Office Use Only)
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This A lication Becomes Your Building Permit When Approved Paid MEM
eipt N.. 0 1 (i2
4512-21 Date.w 1\ INIIIIIIM
Buiidine Official Dat �1
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372