HomeMy WebLinkAboutBuilding 05-0672
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
-I. / _3. ().:5"
~.:~ ~:~ I PERMIT NO'{)6. (J/'7z-1
3. Yellow Applicant . lJ) .
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ~ 4/9.0/2...0
OWNER
(Name)
(Address)
k?< ..... (. j ~~.......... ...&- (~. .'C "'<,
(Phone) roc; (. L( h J.. C(~?~
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APPLICANT () 0,
(Name)~i~ 'f'~ U v n ,. hi '1
(Address) J- L/ I 'fCf H ;tf~ u ; <.--/
(Address)
(Contact Person) ,- ~y'
A v--<.
(Phone) q5".)- LJt)ct- t.:.cterr
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(City) (Zip Code)
(Phone) 101).- ~ 3 "'I '-/9dO
7 jI3)()5
DATE
PPLICANT SIGNATURE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 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 'X Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Penn it #
05.0&72
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
J'9.~O
.50
"'10. 0 ()
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
1-0, d 0
Receipt NOf 980S-
By
Date
Date "'.1-
"f. /~, (;
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