HomeMy WebLinkAboutPlumbing Permit 13. 1124 0 J
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Et CITY OF PRIOR LAKE PLUMBING PERMIT Date Rec'd
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I. Blue File
2.Gold co,AI PERMIT NO. /3. //Zq
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(Please type or print and sign at bottom) 3. Yellow Applicant
ADDRESS
( (oT ?3 ncb ' Se
ZONING(office use)
LEGAL DESCRIPTION(office use only) -�- `, f
LOT J BLOCK ( ADDITION ` ^,4( "`i,� A) 1---c__ PID '75-do7-0a-, o
OWNER
(Name) ' , b i - (Phone) vl —emsoZiO,53(40
(Address) Q ' ill'j
APPLICANT
(Name) Appliance Connections Inc.
12850 Chestnut Blvd. (Phone)
(Address) Shakopee, MN 55379
(Addrej2_445-4803 (City) (Zip Code)
(Contact Person) •
(Phone)
APPLICANT SIGNATURE ,'r///�7 /.. g DATE ?
1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixtureuanti
Q h' Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I 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
The Minnesota Statutes§3268.148 FEE SCHEDULE
"'SURCHARGE"has been extended f job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $ did
STATE SURCHARGE $ r
TOTAL PERMIT FEE $
(Office Use Only) —illi
It
This Application Becomes Y r Building Permit When Approved1411=111r
�] " Receipt No��p 1
5:ii- ' DateC./ tG
Building Official /
Date (� By I
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 -001110
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372