HomeMy WebLinkAboutPlumbing Permit 14. 0637 J
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CITY OF PRIOR LAKE PLUMBING PERMIT .� /
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Blue
File
2.Gold City 6 PERMIT NO. �' &l
Gold rt
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
174'7 S4,0141— il 7
LEGAL DESCRIPTION(office use only)
LOT ( BLOCK I/ ADDITION 6.2,,,,,� 6 A ��� pns,7 ,!�;6- `tom! -023 O
OWNER �(N ) P ' (Phone)
(Address)
APPLICANT ,-) ,
(Name) 1 d 6 �4 �Azi S (Phone) 612— Poi d-(Y
(Address) C2- (/Z -r l t j i9iie di. Pia) STIPtel
(Address) (Ci� (Zip Code)
(Contact Person) RA -,—. 14A (Phone) 61 L-,4U--- I Qr>
APPLICANT SIGNATURE (3-40--11-4/4 DATE )r 7--)7
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 1 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
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit# The Minnesota Statutes 32613.148
"SURCHARGE"has been extended
t`
PLUMBING PERMIT FEE $ 1C q-SY The minimum surcharge for a
STATE SURCHARGE $ VIV
TOTAL PERMIT FEE $ S1 "fixed fee"permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved '. 01
5,�Q Receipt No. ,1 c/ ^
.)ate By �j
Building Official Date l 4- 1 A -
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4110 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372