HomeMy WebLinkAboutPlumbing Permit #12-443 � O� C� ❑O❑OO❑ � O D N�
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� CITY OF PRIOR LAKE PLUMBING PERMIT
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x �,a �. PERMIT NO. Z���
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eau m t aad at.bottom
ADDRESS 1 � ZO1VIIVCi (otr« �se)
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LEGAL DESCRIPTION (oB6ce uu only) ,
LOT BLOCK ADDITION PID
OWNBR . /; �[,/
(Name) �- (Phone) `�I� �" `Y'7 � "� � �
(Address) ^ ( � ��
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APPLICANT
(Name) ' �14 �14 �1....:;.. �_ (Phone)
(Address)
A � (City) (Zip Code)
(Contact�Peason2 ` (c�i W� I �._Y ,u��� (Phone)
�7 � �Iv���-
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
uantl of Fixture uanti of Fixture
Bath 1�b with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water SoRener
Lavato athroom Sink Stand Pi ashin Machine
Laun Tra 1 or 2 co artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Baz Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE .
Indushial, Commercial & Mu14-family 1 yo of job cost wit6 a S49.S0 minimum Residendal, New One Bc 1rvo-Family S I49.50
Rosidentiat, Additiona dc Altaratio� 549.50
The Minnesote Statutcs ¢ 326B.146 . ��st S Building Permit #
"SURCHARGE" has been changed for one
ycar effective PLIJMBING PERMIT FEE $ ��
July 1 , 2010, nntll.lune 30,1A1 t, STATE SURCHARGE s.
The minlmuai :arcAary�e for �"O:cd fas" perm�t '1'pTAL PE1tMIT FEE S
Ia,�, beginbi�g,luiy 1. 2010
Thb Applicatioo Becomes Y'our BnlWing Permit Whea Approved Pzid v .r �!, � Recaipt No. j��� �
� 7 (O
Bulldlrt Otlldal D�te , Date L % E _ 12 BY
J
� 24 `our eotice for all iwpectioas (952) 447-9850, f�x ( N7-4245
1G46 Dalcob Street S.E., Prbr Lalce, Mlariewt� 53372 -
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