HomeMy WebLinkAboutPlumbing Permit 14. 0599 J
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4 PRIp Date Rec'd
0 .M9CITY OF PRIOR LAKE PLUMBING PERMIT
4/4/100
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�'°° rad PERMIT NO. C-
) a.coed c;� �,
Please type or reit and sign at bottom) �.Yellow Applicant
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ADDRESS ZONING(office use)
/x'710 5/(?/./7 P pie /6 d
LEGAL DESCRIPTION(office use only) ,r / -
LOT'3 BLOCK ADDITION 475(r`1"L� l''/ e t) / S '1��til PIT? �- - /Vi a76-- 6
OWNERL �✓
.-
(Name) 5 5412 TCS — Phone9J3 i
{Address}���",e) ��Yln a & Z ../3.'/.0f,/1� 557 .
APPLIC •• SI
(Name) -I_/rafr ". _ =. .k'l _ _._ (Phone) ,,/"!. ____2!� C 32
(Addres i... ;Ye2.... /44). -7-" JL g4/ 55// Q.,,
(Address (City) (
s (Zip Code)
(Contact Person) 4 A / //' ///or"— j/_- (Phone) / '33 siC-_ 6&.-
APPLICANT SIGNATU ' Ar f/:. , DATE 6- -4% • /
— /j
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture - Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher _..
_-- .-., /. .� Water I Icaier
Floor Drain - --.... . . . ............------
_____.____.._..�.—oo _ _.___— ---.- Water Softener
Lavatory(Bathroom Sink) — - Stand Pipe(Washing Machine)
Laundry Tray(I or 2 compartment sink _.._ Sewage Ejector
Shower Stall Backflow Assembly
Sinks
.... . __--- Backflow Assembly Test
Bar Sink Lawn Sp inkier
Water Closet(Toilet) Other
The Minnesota Statutes _ I+EE SCHEDULE
3268.145 I job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended Residential,Additions&Alterations $49.50
The minirnuin surcharge fora
"fixed fee"permit is$5.00 s/Feo Building Permit// 5� -
PLUMBING PERMIT FEE $ `c . 7
STATE SURCHARGE $ X 5.00
TOTAL PERMIT FEE $ ._ _ C,
(Office Use Only) -
This Application Becomes Your Building Permit When Approved Receipt No. /i
-- Date By ,i,iq / !
tluiidine official Date ;;. �� F
24 hour notice for all inspections(952)447-9550,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372