HomeMy WebLinkAboutPlumbing Permit 14. 1062 F. I
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PRI0 CI Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
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LEGAL DESCRIPTION' 0i/
(office use only) //�
LOT 1 BLOCK I ADDITION e/Q ore, /1. �5 j /1dd PIR5- 3o 0 ' I-
10
OWNER
Ramk
P'et,141 soh (Phone) -!J2 l C 3901
(Address)1.2-04e) °ICS-1—n 1 Lek N
APPLICANT Appliance Connections Inc.
(Name) 12850 Chestnut Blvd. (Phone)
(Address) Shakopee, MN 55379
(Akikas445-4803€.ii 11 (City) (Zip Code)
1'C.t
(Contact Person) I tC ' )
(Phone)
APPLICANT SIGNATURE ,u o ) DATE V'1 tt
!PPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher f 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
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 $ Yuv./ Building Permit#
PLUMBING PERMIT FEE $
STATE SURCHARGE
TOTAL PERMIT FEE $ I. 51)
(Office Use Only) , J')
This Application Becomes Your Building Permit When Approved 'd 1I SD Receipt No. /2 /t
By `�
Bafldine Official Date I21
(24 hour notice for all inspections(952)447-9850,fax(9552)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372