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HomeMy WebLinkAboutPLMBG 07-0462 i\~~~ ~~ CITY OF PRIOR LAKE PLUMBING PERMIT p~ ADDRESS 17 J 4-~ S{/11/~ etA. Date Rec'd ~.Il (./7 ~. ~~~ ~il~ I PERMIT NO.07()4-&LI 3 Yellow Applicant . , ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID 2.S:-, {fJs-. {JIO. 0 OWNER (Name) We:.- ~l~~ J'U/"1fZ-A- (!./Z. (Address) APPLICANT L S-,.j '7\ . P I L,t. (Name) L (). .u L1. 0'9 II\!)- Jv~ - I =rf!:' ~ rJ (Address) rJA .s J L-.s /IV" (Address) (Contact Person) APPLICANT SIGNATURE (Phone) iifl- ~/ri S/;rJ 'tJ~ 'IfY S"bJb (Phone) H~fk..ll ~'-r3tj~ (City (ZIp Code) 60dJ( 1jy~ (7 !/r I.; 7 (Phone) DATE APPLICANT PLEASE COMPLETE BELOW 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 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 $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ (Office lJse Only) This Application Becomes Your Building Permit When Approved Building Official Date s%50 dO 4-(j.O Paid 4-0. (J () Date (., {/. (. 7 Receipt No. 5JB 7 L- B