HomeMy WebLinkAboutPlumbing Permit 14. 0609 Z 1Uk
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. date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT 7 / /(0))
I Blue FilePERMIT NO. /) '
2 Gold Crty (.77
3.Yellow Applicant / ,
(Please type or print and sign at bottom)
ADDRESS ..---, ZONING(office use)
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LEGAL DESCRIPTION(office use only)
/0 S /14/04 A 2 ACidd32-31-0-3 z, C�
LOT BLOCK ADDITION PID,A9, '
(Name)
nSp,4. iVilik i (Phone) (A07-351- ��G7.94/1
(Address) A "
APPLICANT
(Name) (Phone)
(Address) 1
(Address), . )"' (City) (Zip Code)
.
(Contact Person) I / .
' A . ; / /: F (Phone)
APPLICANT SIGNATURE I.�IMIr� 1 l_ ,/ DATE Lp(obol
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I 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 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit# The Minnesota Statutes .3 Z613.146
"SURCHARGE"has been extended
PLUMBING PERMIT FEE $ The minimum surcharge for a
STATE SURCHARGE $ C _ .. fixed fee"permit is$$.00
TOTAL PERMIT FEE se
te
(Office Use Only) e 1110
. ^ ^^ ^
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
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