HomeMy WebLinkAboutPlumbing Permit 14. 0612 J
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04 Rip4% L� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File2PERMIT NO. ���"�/
3 App Gold ,
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3Yellow Applicant 111�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID C7'J ` l e� "(�
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OWNER
(Name) (Phone)
(Address)
AN�
t t)' - 6 t'C 'G- j.:�t C (Phone) 6 l a'-? 9 /9'
(Name)
(Name) t ' P
(Address) 3`S S y� f o %A_ Cr AIL-3 �(��wt✓��1 ,N(/v 55712 Sr---
(Address) (City) (Zip Code)
(Contact Person) 2 4L (Phone) 1 ( 2-',2 19 "C/`l7
APPLICANT SIGNATURE (ILA DATE 7- /- /V
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater r(t c i' .C-
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) I Other 1/4-1 v
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
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Estimated Cost $ Building Permit#
The Minnesota Statutes§326B.148
PLUMBING PERMIT FEE $ 449..so "SURCHARGE"has been extended
STATE SURCHARGE $ 5. The minimum surcharge for a
TOTAL PERMIT FEE $ 524,5J "fixed fee"permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 5`"T o'-O Receipt No. , / r r7
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Buildine Official Date Date Z- I • T By 5 , , t
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372