HomeMy WebLinkAboutPlumbing Permit 14. 0636 \
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Date Rec'd
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CITY OF PRIOR LAKE PLUMBING PERM
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7` 7. c'
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Blue File
z.cola City PERMIT NO. /4. �
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3 2 Y(/ / A (,77 E I
LEGAL DESCRIPTION(office use only) C�
LOT fv BLOCKZ ADDITION PID a? '- 1/ 'O/� -d
(Nadi e)R D)f7 ltd r\ (Phone)
(Address)
APPLICANT
ame) Rd .srl l'U 4,144
(Phone) (P/)-' r
17-f4'as'
(Address) -(r VZ- awl kik hv ' 'V
4/6441r0 of u a'i
(Address) (City) // (Zip Code)
(Contact Person) le6 b % (Phone) 6(.2-- r- Irk
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APPLICANT SIGNATURE eri"/ G a� DATE 7—'2-
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 I 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 joh 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§326B.148
"SURCHARGE" has been extended
PLUMBING PERMIT FEE $ 1450
STATE SURCHARGE $ 6—,ea The minimum surcharge for a
TOTAL PERMIT FEE $ 611-5D "fixed fee"permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved ,,---,( `SNo.--7 No7t -
Building Official Date Date ..-7 ` l By 5 ik 35- -.
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372