HomeMy WebLinkAboutPLMBG 06-0439
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 10-06
File
City
w Applicant
I PERMIT NO. () t. ~ L/3 q
I
ZONING (office use)
~.~A--CYLI
LEGAL DESCRIPTION (office use only)
LOT LOCK X ADDITION
, ,
) 1 ShULQ-
PID~_5- 13'-/" 00'/ '-S-
(Contact Person) ( .
q '~<Sh
(Phone){C/Z-~74:-
OWNER ( (
(Name) L ~l (YJ
(Address)
APPLIC
(Name)
(Address)
.t\PPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
ath Tub with or without shower
i washer
F or Drain
L atory (Bathroom Sink)
aundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
~\z.(\ 6~ Industrial, Commercial & M~ I % of job cost with a $39.50 minimum
$~ \,)~\-~ ~.,. it- L~)tJJ
C.\O V '" L\,~ Estimated Cost $ '" Building Permit #
q,(> ~
~b
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'3Q ~SO. .
4O~O
(Office Use Only)
L This Application Becomes Your Building Permit When Approved
Date
L(tJ.---
5'd-~-(,
Receipt No. ,'''
- r;0'-
~
Paid
Building Official
Date
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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