HomeMy WebLinkAboutPlumbing Permit 15. 1225 (2) in 0 O
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CITY OF PRIOR LAKE PLUMBING PERMIT )
�'4vrves�r 1.aim Fig PERMIT NO. r
2.Zed (.tity ��7 , 1 2,2,5----
3.
Yellow Applicant ,,,//
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
dc ''S_ shntcres+ PA NVA) Pz-
LEGAL DESCRIPTION(office use only) �
LOT 4 OCK (ADDITION fir' —D8� e PID 25-- 3F � C
0 CA9N-0
IChY1 )\jJ r u J! (Phone)
(Address) Sivrki......)
APPLICANT nee Connection Inc.
(Name) AIMChustnf►ft Blvd• (Phone)
MN 55379
(Address) Sha{Address03 "+K5.4803 (City) (Zip Code)
Contact Person) 41A . ' t (Phone)
APPLICANT SIGNATURE r4e->'Y-,4_-`* / / DATE q/ sz-f/ l c
f d.... .7----
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 Stall _ Backflow Assembly
Sinks ^Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
The Minnesota Statutes§3268.148 13 FEE HEDULE
oli cost with a$49.50SCminimum Residential,New One& Iwo-Famify $149.50
"SURCHARGE"has been extended + Residential,Additions&Alterations $49.50
The minimum surcharge for a
$ Building Permit#
"fixed fee"permit is$1,00
PLUMBING PERMIT FEE $ in
STATE SURCHARGE $ XXX I.00
TOTAL PERMIT FEE $
(Office Use Only) 51)''60
This Application Becomes Your Building Permit When Approved Paid c--o ,c0 Receipt No. 36:q
•
Date \sO By e.....),-K7'
Bulldine Official Date ��jj (�
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372