HomeMy WebLinkAboutPlumbing Permit 15. 0361 J
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CITY OF PRIOR LAKE PLUMBING PERMIT
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4r 5o4t. t. Blue File
i.cold city PERMIT NO.
3.Yellow Applicant 9 J 3�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
549? cO bOlV l Nb3
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER O1 1153
(Name) D(..� iy) , . I (� (Phone) O� - //0 -'
(Address) a me)
APPLICANT Appliance Connections Inc.
(Name) 12850 Chestnut Blvd. (Phone)
(Address) Shakopee, MN 55379
(Ad.. r ,., . , . (City) (Zip Code)
(Contact Person) .i .alll __ .1 / (Phone)
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APPLICANT SI' NATURE I 4!
/ / / DATE
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 I 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
The Minnesota Statutes§326B.148 I Building Permit#
"SURCHARGE"has been extended LUMBING PERMIT FEE $ /,
5-3
The minimum surcharge for a
"fixed fee"permit is$5.00 TATE SURCHARGE $ X54'DOTAL PERMIT FEE $ A. _
This Application Becomes Your Building Permit When Approved Paid /IME eceipt No d -5
Date , 'Y
Building Official Date I `
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 •
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372