HomeMy WebLinkAboutPlumbing Permit 15-0077 1
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CITY OF PRIOR LAKE PLUMBING PERMIT -.
afINN$soo I.Blue Pik PERMIT NOIS
4.Dela Aly J --
7.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/--9 5 De-ecA /a ,Z)c-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) L U /`
5 -(�__)�,� Yom^// (Phone) ‘76 C/(4 (06 t
(Address) 5 rh-e
APPLICANT !;e �rG !/J i l v. PZ-14-7 ,6) , (Phone) &/n ' 70
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(Name)
(Address) 5L D 1 n j-----e.i'"? C77-75 ao / yW yAji -() /-749 1 !
(Address) (Cit
(Zip Code),S-45--
(Contact Person) _ / . . _ (Phone) (#a 2 d-. . '°\j `,
APPLICANT SIGNATURE DATE / i / t �>
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher °a ater Heater
Floor Drain
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(I or 2 compartment sink Sewage Ejector
Shower StallBackflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) _ Other
FEE SCHEDULE
Tile Minnesota Statutes§3261.1.48 f job cast with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended . ' Residential,Additions&Alterations $49.50
The minimuin surcharge for a .
"fixed fee"permit is$5.00 Building Permit#
-PLUMBING PERMIT FEE $ L 1-• 56
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ - . ci .S
(Office Use Only) -
This Application Becomes Your Building Permit When Approved Paid. v' 1eipt No.Date /
Building Official Date ( ZZ.,,c y
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 `
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372