HomeMy WebLinkAboutPlumbing Permit 14. 0534 J
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. PRION Date Rec'd
0 CITY OF PRIOR LAKE PLUMBING PERMIT 6e /3 /
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441.,Esdit-
l.Blue File
God
2.Gold City l PERMIT NO. ) (7-----4 1'
3.Yellow Applicant C
(Please type or print and sign at bottom)
ADDRESS ZONING office use)
/73/07 224/(/ Dc 56 RI
LEGAL DESCRIPTION(office use only) r
LO 1BLOCK / ADDITION iDer--41 g-66 2 NA/ PID g9.5 37v?-0,37._O
3.(AdOWNER
(Name) (Phone) 4 � .;10_W3.)5-
(Address)
dress)
1�" 1j De_e04e/e/ j) . S
APPLICANT
(Name) Champion Plt.mhjRg (Phone)
PC 000308
(Address) 651-M5-1340
(Address) (City) (Zip Code)
3670 Dodd Road
(Contact Person) _ (Phone)
=Person) , dr
APPLICANT SIGNATURE :.,. 4 -' DATE
Jr
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower ' - _
Dishwasher 1
Floor Drain I i- '
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
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Estimated Cost $ 5J Lr-�•✓`) Building Permit#
The Minnesota Statutes §32613.148
PLUMBING PERMIT FEE $ "SURCHARGE"has been extended
STATE SURCHARGE $ The minimum surcharge for a
TOTAL PERMIT FEE $ "fixed fee"permit is $5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approvedi ‘
id ,/ ,ct m. Receipt No:'il \ 5' --
-
ate ( , By
Building Official Date �� \, \ 6�/
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 `
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372