HomeMy WebLinkAboutPlumbing Permit11. 1227 E 000 0 000000 "0 0 > 20
® 0 ■m -II 0 $ 0 %4
2 2 m k k\ E � i c c m m mo
CI r �� m K\ ■1' 0 d
• / t ��k 0 m z � 2 z2
% 7 > o z L c' k
2 0 ` z xi rn
P3 § 7
Q 13 7
% 0 0000
73 0 q m mm ` m 13en *a m k
� $o 0S -10
§ K? 2 .
ii .n §§ 3§ 2 0 0
Q m > 0 k . m
RI 0 A 0 rmoo
% § m > cc z +, r
2 4 � �" 0 p v
tq o o
) '1, r)
C
2 . ' 000000 , 7
2 5E a .onno
,_ • C kmrnIC 1
\ 0 § _ m m
q m 73 -n ■ 2
k § z
1Z, 0 s-1 pRi Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT ( I (' x
n N ��ESD
1. Blvd File PERMIT. NO / /
3 . Yel Ap r` / / ��
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS . (office use)
? &o ( f M A)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER te a,
(Name) >,_._ . V� • A 1 Ail ( Phone) - l/ .
(Address) - 'e/ �° or --- Lc yy).*1 S S3
APPLICANT Champion Plumbing
(Name) # 61770 -PM (Phone)
651- 365 -1340
(Address) 3670 Dodd Rd-
(Address) Eagan, MN 55123 (City) (Zip Code)
(Contact Person) i 0 . (Phone)
.r
APPLICANT SIGNATURE A ,�. ' DATE ___/-1_3_ --//
�
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower s
Dishwasher L Water Heate
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
L DV
The Minnesota Statutes § 326B.148 ;ost SO Building Permit #
"SURCHARGE" has been extended (Q SO
until June 30, 2013, PLUMBING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ S' v_
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid i ceipt No. L 4,(e4J
Date (( . 10 ( y
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 / V V6 HD