HomeMy WebLinkAboutPLMBG 06-0409
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
at bottom)
I. Blue File
2 Gold City
). Yellow Applicant
I PERMITNO.O~'- !f49
I
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT2 BLOCK b ADDITION
5-r
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OWNER
(Name)
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'bS1 CI)~W1 i<o~
(Phone)
(Address)
APPLICANT L , _ -' ~ \ ~ ,
(Name)~~ r lu..N\Ab\a-
(Address) 2~O~ ~~-t.lJ. f}V<.. ~.
(Address)
(Contact Person) -AL.e.JC 4 tr
-\PPLICANT SIGNATURE
(Phone)
("IZ) ~27-'-IP33
~SW3
(Zip Code)
((.IZ) 82-7-*33
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(Phone)
~~
DATE
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
~?\\ rL Indus~~~mmerci
C\ot;f(; ... tLu.~ ..
l~ lJ ~;II'"'
't,'Y1t\7 '- L
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
& Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ ~dO~. 00
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39 .50
.50
t/" .dO
Building Official
Date
By
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714