HomeMy WebLinkAboutPlumbing Permit 14. 0970 i
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CITY OF PRIOR LAKE PLUMBING PERMIT -. /A' g /q
'•:I:, F''` PERMIT NO. //l t
2.6etd City `7 '
(Pleasetype or print and sign3.Yellow Applicant
at bottom)
ADDRESS ZONING(office use)
1L5\38yore 533CA, - tJi)
LEGAL DESCRIPTION(office use only)
LOT?-BLOCK Ct ADDITION 3e {5 ,4h itt;75'—' 61/-67 7I
(ONaWNER I v[) 1 L/in J../{ l!1 U fl (Phone) Ildt 53(
(Address) 145\3 3'T)(€' Com+- Vi N V VL•
APPLICANT - ( � q - 7Q 30n'' 3 (Phone) Q
_
(Address) &OC{0 Lh1( (/J Taiirn5�.l e, —
(Addres) Q ( (City) I(Zip Code)
(ContactPerson) �� ( e ` (Phone) r�1t'"C
gSt - ���- Of
APPLICANT SIGNATU • " q/via,
DATE -�� �-=1
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 ( 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
The Minnesota Statutes
§326--B.1-.4-.8 f jolt cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended • Residential,Additions&Alterations $49.50
• The minimum surcharge for a $' •/• ' P
"fixed fee"permit is 0 1 Building Permit#
-PLUMBING PERMIT FEE $ (49, SO
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ S1 ,SO
(Office Use Only) -
This Application Becomes Your Building Permit When Approved P SO Receipt No. r) L
Buildine Official Date ate /� (0 + fy 5 -1
(�' l L
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 •
4646 Dakota Street S.F.,Prior Lake,Minnesota 55372
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