HomeMy WebLinkAboutPLUMBING 06-0601
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO.O~ . O~O / I
I
ZONING (office use)
(Please type or print and sign at bottom)
I ADDRESS J5bo3
f} /Mlt6
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
(Phone)
APPLICANT
(Name)
(Phone)
~92-. Z 44-0
55362-
(Zip Code)
4- q Z. Z .tf-4-0
(Address)
souTH /16M/t/V / eA L
2/00S L,qNq;:::O/Z-O /It/&NU6
I
(Address)
(Phone)
..J?)fG,O A- AI
(City)
(Contact Person)
APPLICANT SIGNATURE
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 (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks ~ Backflow Assembly Test
Bar Sink X Lawn Sprinkler
Water Closet (Toilet) I ' Other
APPLICANT PLEASE COMPLETE BELOW
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 $
3950
.50
1-0.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid 4-tJ Receipt No. .5 /74 /
-
Date J. t ~: By
7. ~~.---
u
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