HomeMy WebLinkAboutPLMBG 06-0623
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3 Yellow Applicant
7. /z. () "
rive ~ CiS: /058
PERMIT NO.O&. 0 &2-3
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Pill 25.095 61+.0 I
OWNER
(Name)
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(Phone)
(Address)
APPLICANT
(Name)
RfA1 HA.-t. j t 1(, j
lL.'Z.l. (,.t.,~A"
(Address)
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(Phone) (, I ~ -g, ,- f.. ()if ~
fl~c..~f,.<'(J.. 5"~'Il..3
(City) (Zip Code)
(Address)
'\PPLICANT SIGNATURE
(Phone)
(Contact Persott)
DATE
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 Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEA E COMPLETE BELOW
\, FEE SCHEDULE
q,~\{flJ :;;~l, Commercial & Multi-family 1% of job cost with a $39.50 minimum
c.'O~ I o<?7
c:5 .. "
1>~qb
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.39.sr;
.50
4-t;. tJO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4-0. 0 0
Date.? ? 6 &,
.. / c.-.
Receipt No. .5l? 5""4-
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714