HomeMy WebLinkAboutPlumbing 08-0012
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
2, Gold City
3_ Yellow Applicant
I PERMIT NO. 07. 00/ 2.l
J2d
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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(Address) \,
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(Phone) r )~ -4u3 ~ d' J :y
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APPLICANT
(N ame) Ch::ampinn
651-365-1340
(Address) 3670 Door! Rd #100
Eagan, MN 551~99
(Contact Person) Kr ;~~ () i e h
(Phone)
(City)
(Zip Code)
APPLICANT SIGNATURE
(Phone)
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 Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 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 $39.50 minimum Residential, New One & Two-Family $99,50
Residential. Additions & Alterations $39,50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
LlCf . I.JC
,50
[", i \U' \
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(Office lJse Only)
This Application Becomes Your Building Permit When Approved
Date
Paid.5a. C 0
Date 0 0
/. .
Receipt No.
55/23
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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