HomeMy WebLinkAboutPlumbing Permit #13-074 S � � y �
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. � YRtp Date Rec'd
,� �' CITY OF PRIOR LAKE PLUMBING PERMIT
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�� �. B��e File pERMIT NO
z. coia ccry • � � � '7
3. Ycll�w A��licant
lease or ' t aad s' at bottom
ADDRESS ZONING �ot�ce,�>
1 � �1 a.� �1�er�� �l--n ��1
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER � � e�� S (Phone) f � � � `�' ���'�
(Name
(Address) '��
APPLICANT �� 00�308
(Name) (Phone)
(Address) _ � ��n Qoctci Road
(Address) �� �� 55123 (City) (Zip Code)
(Contact Person) � f� hone
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APPLICANT SIGNATURE � DATE t� l� —�
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fixture
Bath Tub with or without shower
Dishwasher ter Heat
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE 5CHEDULE
Industrial, Commercial8c Multi-family 1% of joh cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residentia(, Additions & Alterations $49.50
Estimated Cost $��� y �' Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGE " has been exr.ended LUMBING PERMIT FEE $
uaitil ]une 30, 2013, TATE SURCHARGE $ 50
The minimum surcharge for a 'OTAL PERMIT FEE $---�,��
"fixed fee" per•mft ys $5.Q�0
a iii� i�ppncasian vca.vmc� � o�r Du,..��ng Permit When Approved Paid�� /� � Receipt No. 0� �
7` }l
Date /j�i� By
Buildine OfYfcial Dste
24 hour noNce for all ➢nspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prlor Lake, Minnesota 553T2
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