HomeMy WebLinkAboutPlumbing Permit 15. 0780 1
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CITY OF PRIOR LAKE PLUMBING PERMIT
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I.Blue File PERMIT NO.
2.Gold /�'O
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
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LEGAL DESCRIPTION(office use only) R7 j do 7- O/5.0
LOT BLOCK ADDITION PID 4F 3 0 O1 o
OWNER /� r 43'5)-9441
(Name) iiI simile e._. .-a _ (Phone) 7' —p I44 1 i o y
(Address)
APPLICANT
(Name) (Phone)
Appliance Connections Inc.
(Address) 1785G Cl -"tnut Blvd.
(Address) Shakopee, IiN 55379 (City) (Zip Code)
(Contact Person) 952-44:iX803 (Phone)
APPLICANT SIGNATURE %. ' ' J i DATE 'rib `
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower (E) Rough-ins
Dishwasher 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
t $ Building Permit#
The Minnesota Statutes§326B.148 + '
"SURCHARGE"has been extended PLUMBING PERMIT FEE $ 0
The minimum surcharge for a STATE SURCHARGE $
"fixed fee"permit is$5.00 TOTAL PERMIT FEE $ 6'9. ko
This Application Becomes Your Building Permit When Approved ` • �,.,\
0Receipt No. 1 ,ri
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P ate /) By
Building Official Date 1 /
ll
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 i
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372