HomeMy WebLinkAboutBldg Permit 15. 0606, 15. 0810, Plbg Permit 12. 0725 3 ❑ 0 C) 000000 -0 0 a 20
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CITY OF PRIOR LAKE PLUMBING PERMIT
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I. cid city PERMIT NO. /) 72
(Please type or print and sign at bottom) 3. Yellow Applicant
ADDRESS ZONING(office use)
t37zLI LH 7® P i L P6tit C,Lc lf h ?rvi 5t3-72—
LEGAL
EGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)
Nap(tc., Ketnncli e (Phone) 952 1+ -7 ftp
(Address)IL 0 1`O(,(fi Wo Com& c k 1 Pn br is -37 -
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(Name)APPLICT ((�� � r`
(Name) t M� VIn.J�I <,��� (Phone) 115 61
(Address) Nit 8V 4 C 5 1(P
(Adds) Ci
_ (City (Zip Code)
(Contact Person) Im b b (Phone) .i tS 3N g&(
APPLICANT SIGNATURE i d /_ ,L DATE // 7/7
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 1 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
Estimated Cost $ It t°C? Building Permit#
The Minnesota Statutes§326B.148 C
"SURCHARGE"has been changed for one PLUMBING PERMIT FEE $ .
year effective STATE SURCHARGE $ _-
duly 1,2010,until lune 30,2011. TOTAL PERMIT FEE $ 51,90
The minimum surcharge fora"fixed fee"permit
is§1,beginning July 1,2010
1.ms Application isecomes Your Building Permit When Approved Paid Receipt No.
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Date Date //4 j/� By \
Building Official /
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372