HomeMy WebLinkAboutPlumbing Permit 15. 0580 J
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT6— (e (.5—
.Bine File
2. City
Gold city PERMIT NO./5:0527
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1 0 4a(-1 Lioli 4 )02, SC- R ) 5_6
LEGAL DESCRIPTION(office use only)
LOT ?BLOCK ( ADDITION Ale/e, �T 1 )LA PID :LO 7-0067.. O
rel eI-) (Phone) / _J 'W
(Name) Li
�� n� �� Vel � ,!/ / - I1 / /
(Address) 54-ryi .i
APPLICANT
(Name) Apro..ance Connections Inc. (Phone)
1150 Chestnut Blvd.
(Address) Shakopee, MN 55379
(Ad§sErsoR
5 4803 (City) (Zip Code)
(Contact Person).....A m 1 (I( (Phone)
APPLICANT SIGNATURE on-
APPLICANT DATE 5l ( PO/ S
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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 $ Building Permit# The Minnesota Statutes§3Z613.14ti
"SURCHARGE"has been extended
PLUMBING PERMIT FEE $ d. The minimum surcharge for a
STATE SURCHARGE $
TOTAL PERMIT FEE $ "fixed fee"permit is$5.00
(Office Use Only) •
This Application Becomes Your Building Permit When Approved '/4 3ry/' T w, ^ +^
Receipt No. /5—z 3
L /`T `
(A
Bnildine Official Date I
Dates
, ( , (s.„-- By SA-
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372