HomeMy WebLinkAboutPlumbing Permit 14. 1173 L
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04 PRION Date Rec'd
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,f CITY OF PRIOR LAKE PLUMBING PERMIT r
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4y se I.Blue File
2.Gold city PERMIT NO. I •(+)073
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
314q �6Dc� '' fyI c
—119
LEGAL DESCRIPTION(office use only) /�l e
LOT j BLOCK 2- ADDITION j' , III GSC s $ 2 o')' pm j% 8;3-C7io
OWNER
(Name) i► a ,! /, v L e- (Phone) 956q- " 47`t"
(Address)
APPLICANT
(Name) Appliance Connections Inc. (Phone)
(Address)
12850 Chestnut Blvd.
(Address952-44�-,Shakopee, I55379 (City) (Zip Code)
:03
(Contact Person G '1111b-1 11 G (Phone)
APPLICANT SIGNATURE ii 4//40 / /1 „is . DATE
•
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher a 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
- E
Industrial,Commercial&Multi-family 1%of job cost with a:e 9.50 minimu t Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit# lute 1v111111eJULd 3LaCULCJ J'UD.1`tO
(I "SURCHARGE"has been extended
PLUMBING PERMIT FEE $ °1i i The minimum surcharge for a
STATE SURCHARGE $ >IN "fixed fee"permit is$5.00
TOTAL PERMIT FEE $ ��
(Office Use Only) . n
This Application Becomes Your Building Permit When Approved th,, ';3 S^b Receipt No. et nc
Da
Building Official Date ^ •�+ By <-
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372