HomeMy WebLinkAboutPlumbing Permit 14. 0380 EF n 00000 -00 a 20
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CITY OF PRIOR LAKE PLUMBING PERMIT 5 / , /4/-
4121g / , /c/-
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I.slue File ./ .PERMIT NO. ILsD
i.cola City r
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
'VV (,,�,��I(�'o� be(-c. . > /
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION , & PID 075%- /D6' D
(Name)OWNE �� I c� K. c O Z- (Phone) 0 2 7 7 6— 5 3 3
(Address) ( a i Ms-) bec>,GN., xC' .
APPLICANT /F�
(Name) V' pc (Z1 �t (Phone) 6 (a' 59g-- cr/0 4
(Address) /0 710 /12/1 .5 '5 fP + 54 i:✓ zoo", R.41%S.5 6-513_3
3_3
(Address) (City) (Zip Code)
(Contact Person) 1TG�v ( D' -*-S (Phone) 16/ ` 2eO
APPLICANT SIGNATURE L! DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
I 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
k Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) r Other S)S-f e
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# i ne IvllnnesoLa 3tatutes g 3GCF>S.14•3
S� "SURCHARGE"has been extended
PLUMBING PERMIT FEE $ The minimum surcharge for a
STATE SURCHARGE $ "fixed fee"permit is$5.00
TOTAL PERMIT FEE $ Sa
(Office Use Only) 7,
Tl.... TA....« ..�� �L..4...4.... c •)�)/P I AC)
This Application Becomes Your Building Permit When Approved 5T � , Receipt No.,7/2.z/'
5 1(p. / VDateZ1.14 /
. ! ` By
Building I ' Date ✓ + /V + f 7`"
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372