HomeMy WebLinkAbout17563 sw permit '° PLUMBING - MECHANICAL - SEWER WATER
{ City of Prior Lake I Building Inspections
4646 Dakota Street SE Date:3j^2J—Z 7 Permit#
Office:952.447.9850 permits( PriorLakeMN.��v
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SITE INFORMATION
Site Address `—'�s(P 3 v�� `J ` 1 ��D Parcel ID
Lot Block Subdivision r ►.�A
Owner
P►Q�S_�,%Vu Address � ,�e \ i Phone 95 Z.�tfi
PERMIT DETAILS—call Gopher State One before you dig 811 y
TYPE OF WORK X New ❑Alteration ❑Addition ❑Repair ❑Replacement
❑ Plumbing(Qty/Item) X Sewer&Water
❑ Mechanical
Bath Tub Rough-ins Size of water Service_/inches
❑ Warm Air Plants
Dishwasher Water Heater Location of couplings from Structure
/ft. ❑ Gravity
Floor Drain Water Softener Type of sewer pipe❑ ABC 0 PVC
❑ Cast Iron ❑ Air Conditioning
Lavatory(sink) Stand Pipe Estimated Length of sewer line__/ft ❑ Vent System
Laundry Tray Sewage gector Clean out(if required)location at._/ft
from structure ❑ Steam/Hot Water
Shower Stall Backflow Assembly Other: ❑ Other:
Sinks Backflow Assembly
Test ❑Furnace Make/Model
Bar Sink Lawn Sprinkler
❑Fireplace Make/Model:
Toilet Other.
APPLICANT/CONTRACTOR INFORMATION ❑Work being completed by property owner must be owner occupied
Applicant/Company Name North Star Excavating License No PB777900
Address 21483 Grenada Ave # 920 Email staGys@northstardirt-.com
City Lakeville state MN zip 55044
Contact Person Stacy Stocker Phone 602-552-5268 Fax
FEE SCHEDULE
Fg
ustrial,Commercial,&Multi-family 1%of job cost(min.$49.50)
dustrial,Commercial,&Multi-family 1°i°of job cost(min.$25.50) Valuation$ x.01 $
&Mechanical New $154.50
g&Mechanical Alteration $54.50 Water New X $56.50r Water Repair $30.50 $
State Surcharge Fee
Commercial over$1,000,000=value x.0005 $1'Q0 $1.00
Total Is
SIGNATURES
I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance to provisions of the ordinances of the
City of Prior Lake,the State Plumbing,Mechanical,Utility,and Building codes. 1 further agree that any plans and specifications submitted herein shall
become part of this permit application.This permit will expire in six(6)months from the date of issue if a passing final inspection is not obtained.
Signature of Applicant Date
Printed Name of Applicant Stacy Stock
J:\Handouts and Permits 2021\Plumbing Mechanical Sewer Water Permit(Fillable)2021