HomeMy WebLinkAboutPlumbing Permit 16. 0041 CD
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®4 pRi � CITY OF PRIOR LAKE PLUMBING PERMITI ,Z l
a
vxrseLDERNIHIT ---Ia.Yiry NO./4,00L/Yeflow Applicant
(Please type orprint and sign at bottom) -
--
ADDRESSZONING(office use)
/ WI- (0e,-33tre_s_s k)I'd -
R2-
LEGAL DESCRIPTION(office use only) /
LOT 13 BLOCK 6 ADDITION &e../I752,7)9-72/2 / i 4) PID 25- 3'7 ,-.. 5---z -0
OWNE' r M.1161-e- --
- (Phone) L 519?'"� " gJft/
(Name) /. � /i Q- _
(Address) _
APPLICANT
(Name) (Phone) — -
AppMence:;Connect $Inc.
(Address) .:. .1 . 1.-.:. tit.Blvd.
(Address)Shak. • , N 5- (City) (Zip Code)
\n`
g • :03
(Contact Pers.' 4 IAA �/ . 0 hone) -
APPLICANT SIGNATURE / // :
_ _ AP r DATE '
I
AP fICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity • Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher a ` 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
The minimum surcharge for a PLUMBING PERMIT FEE $ 1/1
,
OD
"fixed fee"permit is$5700- STATE SURCHARGE $ L
10 0 TOTAL PERMIT FEE $ 5O,
This Application Becomes Your Building Permit When Approved Paid Go Receipt No. 5q /„ 3
y, R Date t (n By
Budding Official Date V-ZO• 1 "'' -7... .,/7( (
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372