HomeMy WebLinkAboutPlumbing Permit 15.0972 z
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04 4R o Date Rec'd
t CITY OF PRIOR LAKE PLUMBING PERMIT
,. Blue File PERMIT NO. 24
2.Geld City 7-7' •3.Yellow Applicant
(Please type or print and sign at bottom)
A7118E .SI n i ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER k\.\\,, C_ 0 ,\ ''S
(Name) \ -c_�Se�J (Phone) cc - 351 -g�a 1
(Address) \' to 2 4-"k5 Cal...rIL\l`\-e w \ f'. 1%1\ ) 6- S...1'..-1 2'
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE DATE €?r4-Z-\ '- \
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher >j 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
The Minnesota Statutes-§326B.148 ` Building Permit#
"SURCHARGE"has been extended LUMBING PERMIT FEE $ of f 51)
The minimum surcharge for a TATE SURCHARGE $ 1.*9
"fixed fee"permit is$5.00 OTAL PERMIT FEE $ 371. 57,
This Application Becomes Your Building Permit When Approved Paid JC2,32:7 Receipt No. 4 z_z___
Dates G �t'ir By
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372