HomeMy WebLinkAboutPLMBG 05-1245
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/18/2008
.~" ~NE5~
Date Rec'd
fY OF PRIOR LAKE PLUMBING PERMIT
l{EQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 10-06
:~ ~:~ \ PERMITNO.(!)5.IZ~1
Y.!low Applicant . .
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID JS'. ZiS'. oos.O
(Address)
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c; S~7~
(Phone) C)S;} , 445 --- 19;).~
OWNER~
(Name) ^ Y'\.,.Q
(Address)
CULliGAN WAfcR C0. ~! i jI..) '. lot...;
5030 CULLIGAN WAY
MlNNETONK,~. MN 55345
(Address~Si;~) "'1?7~O~
APPLICANT
(Name)
(Phone)
(City)
(Zip Code)
<\PPLlCANT SIGNATURE
(Phone)
DATE
(Contact Person)
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain i 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 PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial. Commercial & Multi-family 1 % of job cost with a $39.50 minimum
t5>~
Estimated Cost $ ;).(j)
Residential, New One & Two-Family $99.50
Residential. Additions & Alterations $39.50
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3'} . q:y
.50
YO .' 6C\
(Office Use Only)
Building Official
Date
Paid .L
rU-
Date .' r
(2 7-P ~VJ
Receipt ~? 5ZI g ~/
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