HomeMy WebLinkAboutPlumbing Permit 15. 1173 > . .
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4 CITY OF PRIOR LAKE PLUMBING PERMIT -. Zgl c
/113
't' so'tt' }.slue Fie PERMIT NO. ✓
2.zed City / gag
3.Yellow Applicant
(Please type orprint and sign at bottom)
ADDRESS ZONING(office use)
502.20 6 • Oak )h-',D`' R (
,
LEGAL�DESCRIPTION(office use only) / f�
LOT" ?BLOCK ADDITION Z)�-,--7e126-7,6 /7 - 1Q,Q40 PID a✓ ` 0/1-D3 7- b
OWNER -`'3a- 7/a-qv-73
.‘(Name) r -4 V . 4
(Phone)
(Address)
1t1�
APPLICANT
(Name) (Phone)
(Address) 12850Ch nut Blvd.
:1 4:4 .-/ ' ;03 (City) (Zip Code)
(Contact Perso j. Iii / / `/ ,Al,...-0 (Phone)
APPLICANT SIGNATURE /44. _ .�� DATE / S
i ./A
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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
§326B.
The Minnesota Statutes 148 Tj oli cost with a$49.50 minimum Residential,New One&Tw0-Family $149.50
" "has n Residential,Additions&Alterations $49.50
The miniSURCHARGEmum surcbeeharge for aextended •
"fixed fee"permit is$5,00 $
Building Permit#
PLUMBING PERMIT FEE $ tel
STATE SURCHARGE $ XXX $.00
TOTAL PERMIT FEE $
(Office Use Only) .60
This Application Becomes Your Building Permit When Approved Paid5vS'o Receipt No.241 Z-
,
Date �f2-Y-
/ Cy
Butldine Official Date / Z [ �?_
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372