HomeMy WebLinkAboutPlumbing Permit 13. 1072 J
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P Date Rec'd
N 'e CITY OF PRIOR LAKE PLUMBING PERMIT
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oid City PERMIT NO . l 2._..
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRE S I o .■ ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER i +
(Name) ( k l ' ) G h i I e (Phone) 1 ij ( ' & 6 O ` (7(p
(Address)
APPLICANT
(Name) . __.a_,....e en11Y Of$-MC. (Phone)
(Address) 12850 Chestnut elvel.
t (City) (Zip Code)
(Contact Person) , �a yyt ( t rPo i (Phone) re.....9„:____
APPLICANT SIGNATURE DATE q ?Di
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 Water Heater
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 I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 1 Building Permit #
"SiJRCHARGE" has been extended LUMBING PERMIT FEE $ 41•1)
The minimum surcharge for a TATE SURCHARGE $ Ai
"fixed fee" permit is $$.00 OTAL PERMIT FEE $ -"L
This Application Becomes Your Building Permit When Approved Paid , 4 J-4z , sv Receipt No. 7d4 /I )
Date By By
Building Official Date /+c3
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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