HomeMy WebLinkAboutPlumbing Permit 14. 0524 J
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04 2R104. Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT - ‘'' f3 , / 4/
U
K.'_vivaso�� 74,52/--/
I.aloe Fite PERMIT NO. /" ! --�'
2.Gaud 2e
3.Yellow Applicant
(Please type or print and sign at bottom)
1V
ADDRESS'I tt 11 ZONING(orrice use)
)L5' `C SG' vi t i cQ ea k e 9 s'gt cl/e: 1. . O. A-)2-
LEGAL
J2-
LEGAL DESCRIPTION(office use only) ` �/
LOT BLOCK ( ADDITION `tie_495 4-/(y / 2r, LOA) PID, :?5 /�� �Z)��
OWNER p-2
(Name) �'.7-i c U t'.t o t,t.) (Phone) 6t5 2. CI q 4- 4497
(Address) (,;31lO alaeAtue,,5 --R, 9e----Ri . N.a.
(Name) V rat(IT( 0?tor- iK r .JA C , (Phone) c' SZ �G (4 q 9
(Address) SF t 5 20 9-b LQ-I-e-i 1 (te. 55 044-
(Address) (City) (Zip Code)
gq
(Contact Person) Y F o r (Phone) 5 Z 41 �o q
APPLICANT SIGNATURE d A DATE (1-5' I `c
APPLIC'11577'LEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher ( 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
I Water Closet(Toilet} Other
FEE SCHEDULE
The Minnesota Statutes§3268.148 Ti
ob cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended . r Residential,Additions&Alterations $49.50
The nlininluin surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $ 4R.5o
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ 54.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved P k, \ V Receipt No. � ) S
DI D ' _" By
6
BuildineOfficial Date \ "7 , `q 51-\
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372