HomeMy WebLinkAboutPlumbing Permit 14. 0533 J
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4 PRION Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
so � '.Led Flit PERMIT NO. / j
3.aotd Applicant
//�• 3 3
3.Yellow Applicant I
(Please type or print and sign at bottom)
ADDRESS SI �4 Wcoaciticc
p �� L ZONING orrice use)
LEGAL DESCRIPTION(office use only) d/
LOT (ROCK ADDITION IUl l✓ 4-1-• PID Z' 7- 0 --.0
O(Nam ER eir- c flctr1oxv \ (Phone) S z 4/1-2 1 3
(Address) 151 L k' (AbodC,..V(.c' TftL
APPLICANT
(Name) eCilC '] / �/Z- \ J(Phone) 9 Z" 0-100 0
(Address) 12-CO (A HUD\.J i 3B 5v Ir l(C S S J
(Address) (City) (Zip Code)
L&
(Contact Person) i 0 (Phone) S[,-- 1- _
APPLICANT SIGNATURE B__MR, DATE / I i° c
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher al 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
The Minnesota Statutes§326111'48 Not;cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended . ' ' Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5.40 $ Building Permit#
•PLUMBING PERMIT FEE $ LI'9 •SU
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ 5 L( __SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved 41. / -0 Receipt No. 1` 15 2C. .
t ateBy
Bulldine Official Date Lc t� , 0- 51x
i
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372