HomeMy WebLinkAboutPlumbing Permit 15. 0873 J
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O�PRI0 Date Reed OF PRIOR LAKE PLUMBING PERMIT •.
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art• -
z:aoW Ty PERMIT NO. - /
3.Yellow Applicant •� O
(Please type or print and sign at bottom)
ADDRESS ZONING(orrice use)
33Rg SpriN) (&L.eh CI'rc(Q NW PZ
LEGAL DESCRIPTION(office use only) *112c44-?
LOT t BLOCK 2- ADDITION 47 6..) --E---, PID ,75--357"Do9"--c
OWNER
(Name). M t Ghat( Pp c k e r
/ /' j- (Phone)
W.01- 61.14647
(Address) 3391 Sprit , Gleh Ci'rck NW Pr(i,r- Lake, /VI✓1/ GI 2.5
gCv(s87
APPLICAIV , „ i ,
(Name) 6f-0 6-1 ► i ate( A Aar t,ol c"tl ok ri (Phone) qrz (31 " 777 7
(Address). 15g g k it +04,. A S - W,- Pi 4:-1f{ 555 w
(Adess) (City) (Zip Code)
(Contact Person) A-71-4 on y (Phone)
APPLICAlsIT SIGNATURE C-14 Ilam DATE 077 -3/I
1 APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity . Type of Fixture
Bath Tub with or without shower Rough-ns
s
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
The Milinesata Stattites - FEE SCHEDULE
"SURCHARGE"IIIas been xtended - . pot;cost with a$49.50 minimum Residential,
d j AddiNew tions s&Alterations $49.50
The minimusurcharge for a q
"fixed fee"permit is$5.00 $ £ I 1 Building Permit#
•PLUMBING PERMIT FEE $ ii9.5-0
STATE SURCHARGE $• 14OO X)$) *4121
TOTAL PERMIT FEE $ D.Sb
(Office Use Only) • .
This Application Becomes Your Building Permit When Approved WM= Receipt No. ValDate 1 gy
C) Building Official Bate f
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372