HomeMy WebLinkAboutPlumbing Permit 14. 0013 CD JQ
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O�pRiO Date Reeda� CITY OF PRIOR LAKE PLUMBING PERMIT
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4r °.�� l:BIUe FA PERMIT NO.
2.Gold City 14-013
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1IID 77 fOLS.Q►- 'l .ICD Cr S1. S531a
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 1\G \y '/5 rn f.9--{
n_ (Phone) 1.5-,D - 510 y - 2 0 0 c(
(Address)
APPLICANT CULLIGAN WATER CONDI nONING
(Name) 6030 CULLIGAN WAY (Phone)
MINNE I UNKA, MN 55345
(Address) (952) 933-7200
(Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE4R .1 DATE I D - I5 -_(3
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
The Minnesota Statutes§326B.148 FEE SCHEDULE
"SURCHARGE"has been extended 'job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $
STATE SURCHARGE $ 5„ ,,-,,i'
TOTAL PERMIT FEE $ 5 y ,—CO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid j-4 c Receipt No. 7� Li 4
Date i4//y_
/6//y_ By
Building Official Date ,c.-). `/9.4,— •
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372