HomeMy WebLinkAboutPlumbing Permit 15. 0685 &
Date Rec'd
0 g IN CITY OF PRIOR LAKE PLUMBING PERMIT1�'
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5e 2.BlueoFile PERMIT NO. / . 0/
3.Yellow Applicant
(Please type or print and sign at bottom)ADDRESS W J ZONING lj(office use)
333 \ \vrwit-\-eArTfo:41
LEGAL DESCRIPTION(office use only) 1� N 1)/� PID '���34'5:#LOT 'BLOCK ADDITIONC R)
OWNER . QXl'�i (Phone) i&_...,s .
(Name)
(Address) S CAney-ye..—.
APPLICANT Champion Plumbing
(Name)
PC 000308 (Phone)
651-365-1340
(Address)
(Address) 3670 Dodd Road (City) (Zip Code)
Ea,an, MN 65123 (phone)
(Contact Person) /� "
_ -s „iii �� DATE (.0' / �• f
APPLICANT SIGNATURE 5
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APPLICANT PLEASE COMPLETE BELOW Type of Fixture
Quantity Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain Stand Pipe(Washing Machine)
Lavatory(Bathroom Sink) Sewa:e Eector
Laun a Tra 1 or 2 corn•artment sink Backflow Assembly
Shower Stall Backflow Assembly Test ,
Sinks Lawn Sprinkler
Bar Sink Other
Water Closet(Toilet)
FEE SCHEDULE ' 6)
Industrial,Commercial&Multi family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $1 i 4
Residential,Additions&Alterations \
st $.1:2 t9 - Building Permit# \ 1
The Minnesota Statutes§326B.148 /\\\
"SURCHARGE"has been extended PLUMBING PERMIT FEE $ 50
The minimum surcharge for a STATE SURCHARGE $ r�
"fixed fee" permit is$►.00 TOTAL PERMIT FEE $ S'7 x S v
's�» 1 / Receipt .grip �
This Application Becomes Your Building Permit When Approved - .,
11
Date u .`• By
Buildine Official Date . , ill,hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372