HomeMy WebLinkAboutPlumbing Permit 15. 0646 C.1
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CITY OF PRIOR LAKE PLUMBING PERMIT - . ,,,
40t ` S
kscist•
I.at!e Cit PERMIT NO. /5; o6 I
z Geta FA 7`
3.YetteN Applicant
(please type or print and sign at bottom)
ADDRESSZONING(office use)
S4 So
_ SrJ LL_ Coux 3. E . Ri
LEGAL DESCRIPTION(office use only)
LOT C9 BLOCK // ADDITION O 4" L �r 111)07,51 500' 057 —0
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(NVaVmNe))R r{ 11- 6 l r✓4 lV1 (Phone) &)2-2O5-29 72-
(Address)
Z(Address)543 J (5Nei/) C, .-f CSC
(Name)
APPLICANT & fie. C ' C (Phone) 9
hPs N i Ci95-2_---753- SOT
(Address) 4 '20 4-14‘ 5+ N V r.(J geV' -ei� U� 56 0 7/
(Address) Ofty) (Zip Code)
(Contact Person) - 1 f , S 0 - (Phone)q50 ---/S. g -g695-
APPLICANT
69'JAPPLICANT SIGNATURE ;..�% K d/ DATE 6//6,1/ ---
-
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain 1 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
FThe Minnesota Statutes 32613.248 ol;cost with a$49.50 E SCHEDULE
E Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended - • 13
Residential,Additions&Alterations $49.50
The minimum surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $ -49- 5U
STATE SURCHARGE $ Xn 5.00
TOTAL PERMIT FEE $ S 4 .. Sz)
(Office Use Only)
This Application Becomes Your Building Permit When Approved 5-4.iso Receipt No. ' 1
BuildinnOfficial Date Dat, . Kt By
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street B.E.,Prior Lake,Minnesota 55372