HomeMy WebLinkAboutPlumbing Permit 14. 0611 I O O
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CITY OF PRIOR LAKE PLUMBING PERMIT
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1.GolBlued FileCity PERMIT NO. /,i �/
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/ .7 iu 7)-f--4. <+,c i 1)1 C4 A6u0 z_A- JE kr
LEGAL DESCRIPTION(office use only)
LOT /`f//BLOCK 2-ADDITION f96-ws-m/i:"Re 't6 C/e. /03e, PIDJ75- S o. '5 —O
OWNER
� Cul��Y Co A)A.)/15--i;
(Phone) ?-S-
(Name) 47 (V 0 _-- V 7/2
(Address) �-} 'q'1 E
APPLICANT
(Name) LL/iv l ln ,+25 7/(c c:J4 r C O (Phone) 26/3- - ?_ 7 7c,/
(Address) * SZ' i -25 Cc SC C. M(,'t ,<,),_:--- , (1-(r" -,S Yy y
(Address) (City) (Zip Code)
(Contact Person) Z-/- e/T1 �` "'� (Phone) 7 "� 5 " 7 7Q/
APPLICANT SIGNATURE )J:z(2-' c,,-i-r.,' DATE '/'-'Z 0
z l cj�,(..J]rte ,41,5-73-,..:If (Jcli,
_ APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain 1 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 $ 7- • c'C' Building Permit# �f
-
::71-31t
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended PLUMBING PERMIT FEE $ e.‘until une 30,2013,I STATE SURCHARGE $ .50
The minimum surcharge for a COTAL PERMIT FEE $ 5 V. mac)
"fixed fee"permit is$5.00
.....-.Yt,...,at,u„„c.;u,nes x our nuuaing Permit When Approved d c` Receipt No. i 11 3
Date B
Buildinc Official Date y
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 ✓
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372