HomeMy WebLinkAboutPLMBG 07-0054
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
I ]0 01
\.
I. Blue File I PERMIT NO I
2 Gold City . U'1.. u 0' ~ 4-
3 Yellow Applicant ~'
ZONING (office use)
~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID_~ r. I (; I . c iJ 0
OWNE~";J 0
(Name) e.n h(Y)
(Phone) 950-'/1 D..;}'];;/
(Address)
I\PPLICANT SIGNATURE
05'~ '<JID. t3:t b
55/
(City) (Zip Code)
(Phone) ~ - 3ps~ 13'--{ 0
(-
DATE
(Address)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I 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
FEE SCHEDULE
Industrial. Commercial & 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 $ ;]00, 00
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
3q.So
.50
40.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid If {/ () (;
Date >? () . 1
/. .5 {/
Receipt No. 3- 2 b 4--tJ
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
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