HomeMy WebLinkAboutPlumbing Permit 15. 0860 o
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31 pitiO.p Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
v
I.Blue File e FileNO.
d Applicant PERMIT
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
i e4 a 4 Ci ve.hoo ks Ave, 3 5537 a , Z6-16
LEGAL DE RIPTIO iy(office use% y)
LOT BLOCK A r$ITION Afrifrs,,----- a PID 07,5---4e-01,--t
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(Name)
ER�ctu,e, 5e i✓-sO1/ (Phone) 9(5 --4 46- o 5
(Address) {(0 494. ct,ve CtukS A- 3 5 5 3 ) a
APPLICAN
(Name) X )Q1 Y1CQ, e_Onno( 4'7 G/L (Phone)
(Address) 0 g50 C1tash S-- 8l lid Skokopf2L 563 7 9
(Address) (City) ,/ (Zip Code)
(Contact Person) _ l �i � ,t 0 i1 ' 1 (Phone) Q5?- `f A 45- 4 8C.,.
APPLICANT SIGNATURE trA MI DATE Arip3..4 "
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 Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink , Sewage Ejector
Shower StallBackflow 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 )at $ Building Permit#
"SURCHARGE"has been extended
The minimum surcharge for a PLUMBING PERMIT FEE $ 9f
"fixed fee"permit is STATE SURCHARGE $ / .
/, l TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Iid 60 GO Receipt No.a3
3V1
Date1 . - i c By 3 25,'...--'
0..4
Building Official Date 2 c
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372