HomeMy WebLinkAboutPLMBG 05-1168
THIS FILE HAS BEEN
CLOSED DUE T()
INACTIVITY 4/18/2008
Y OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
/1. q. oS-
- ~ ;;;J
""NNESO""
1, Blue File
2. Gold City
3 Yellow Applicant
I PERMIT NO. O~. I 'lPD I
ZONING (office use)
553l Q
lro k- 6.vc le
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25'. $35"" 0
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OWNER
(Name)
JQ..~
.,
~
(Phone)
q~ -adl.o-EJ.3J'f
(Address)
:;;~~ANT ~~ W~
(Address) jo 111 :?P- Au-e- S!tJ
(Address)
~~;S
Wid -~O/-5d~O
Hu-1C.1tUt~ 5J?DO
(City) (Zip Code)
(Phone)
APPLICANT PLE
Type of Fixture
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)
~'\J \:) V \a.W~ tvy"
(Phone)
~
(Contact Person)
\PPLlCANT SIGNATURE
DATE
Quantity
COMPLETE BELOW
Quantity
Type of Fixture
\
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
\0\1\ S'fS
E SCHEDULE
I &tfL-
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
69, Ci)
.50
t-IO,(1)
(Office Use Only)
I
This Application Becomes Your Building Permit When Approved
Date
Paid # __
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