HomeMy WebLinkAboutPlumbing Permit 12. 0202 O pRio. Date Rec'd
a CITY OF PRIOR LAKE PLUMBING PERMIT
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I.Blue File PERMIT NO
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2.GoldApp . /1 2.7:0(-2)2.7:0(-2)3.Yellow Applicant �
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
IW ®6 Co (Ai 11 6-c- c f
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ���'�r��
(Name) l. 0 PO L/i U/Z OD6 A 7-/ (Phone)
(Address)
PPLICANTr tit&(1 °L LWw 41 fit,V c eft (Phone) 6 9-43 7 3j qV�
(Name)
(Address) /g 0 �",'0!("1. nrx,''-e_ P/4'4 e 5C0/t
(Address) (City) (Zip Code)
(Contact Person) (ZvLCt-4 / A"1 (Phone) 372%— 745 rte` Wo
APPLICANT SIGNATURE f ` DATE -5-2, 7 J2
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
3 Floor Drain Water Softener
1\ 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
'R 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
fes' Residential,Additions&Alterations $49.50
'ost $ l gie CV Building Permit#
The Minnesota Statutes§326B.148 Q
"SURCHARGE"has been extended PLUMBING PERMIT FEE $ /S 0; co
until June 30,2013, STATE SURCHARGE $ 5. Q
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee"permit is$5.00
This/ Your Building Per it Wh Approved Paid/6 ,,t o Recei o.ivy :'5
BIT,iniiie Official �te IS r�Dated � � �� By
24 hour notice for all inspections(952)447-9850,fax(952)447-4245.
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372