HomeMy WebLinkAboutPlumbing Permit #12-1382 � ❑ ❑� C� ❑O�OO❑ '9 O > Zc�
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°"� ���� CITY �F PRIOR LAKE PLUMBING PERMIT
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�INNESO�P L Blue File PERNIIT NO
2. °°�� �y I� -I.3 �L
3. Yellow A�licxnl
ease or t and si n at bottom
ADDRESS ZONIl�TG �o�« ��
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWi\rL�: � ,�l "7T1' � L LP
(Name) °� � (�U (Phone)
(Address) 4�2. � �1 �}'
APFLICANT S
(Name) �C li►,hnvs « 1 V1��G�"Ilfl � � ��1.Q hone) ��� �J7- ��� �
(Address) ��I O�-I U�I/ IM (� l 1 O V1 , 1�.C-�-�,� fi [.� S'� YI FiS T —�.�/]��� 3
(Address) �� (City) (Zip Code}
(Contact Person) �Q .w�.t � L����N�a1' {Phone} � � "i' �-'�1 � � X 2�
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APPLICANT SIGNATURE DATE �( Z 2 '
APPLICANT PLEASE COMPLETE BELOW
Qu�nti T e of Fixture uanti e of Fixture
Bath T�ib with or without shower Rou h-ins
Dishwasher � Water Heater
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e Washin Machine
Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
�3ar Sir1c Lawn S rinkler
Water Closet Toilet Other
FEESCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Resideniiat, Additions & Alterations $49.50
"Fhe Minnesota Statutes § 32GI3.]4R � �st $ $uilding Permit #
"SLI[tG.l-IARGE" I�as been chai�ged for one � 5
y�ar eifective PLUMBING ,PERMIT FEE $
Ji�ts' D. 20�0 antil ;iu�ie 3fl ZO! i. STATE SURCHARGE $ �,�4 .54
The miaimum surchnrgc for a °tized fee" permit TOTAL PEItMIT FEE $ SC.� . S[)
is ,'��'S, be�inning.Juty 1., 2010 —�—
This Application Becomes Your Building Perrnit When Approved Paid �' L � Receipt No. ����
�7
Date // �� � By �
Buildlne OfBcial Date
24 hour noHce for a!I inspections (952) 44'i-9854, fax (952) 447-4245
4646 Dakota Street S.E., Prlor Lake, Minnesota 55372