HomeMy WebLinkAboutPLUMBING PERMIT 16-1442 SIMS
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CALL 447-9850 FOR THE NEXT IN ADVANCE.
Inspector. INSPECTION 24 HOURS
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�V1004 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
�. Blue File ,PERMIT NO.7
2.Gold City ,/4-4-
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
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I a L L t. 5 6
. ,LEGAL DESCRIPTION(office use only) Y • 31_ '
LOT BLOCK ADDITION PID
OWNER / / )'7 ~&WW".57/q
(Name) � A _ � /� 4 L, A Alb / , 1 (Phone
(Address) 1,illi
APPLICANT
(Name) appliance Connections inc. (Phone)
12850 Chestnut Blvd.
(Address) Shakopee, MN 55379
(AddresP2"445-481'1 (City) (Zip Code)
(Contact Person) 11'' m'� "e.- 124: ..e/ (Phone)
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APPLICANT SIGNATURE DATE ` , 1
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 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 PLUMBING PERMIT FEE $ �!
The minimum surcharge for a STATE SURCHARGE $ L die
"fixed fee"permit is / TOTAL PERMIT FEE $ 57 5V
This Application Becomes Your Building Permit When Approved Paid .5-t V50 Receipt No. --1-7- U 0
Buildins Official Date Date l
1,Z' .Z i .N
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372