HomeMy WebLinkAboutPlumbing 08-0163
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~.:~ ~:~ I PERMIT NO. O.~. 0 I' -zl
3. Yellow Applicant , CJ \Q...:;).
ZONING (office use)
\ 411\ L ~:u.:ccd \2d ~t..
LEGAL DESCRIPTION (office use only)
PID
LOT
BLOCK
ADDITION
(Contact Person)
I.-
OWNER
(Name)
(Address)
APPLICA
(Name)
(Address)
DATE
, PPLICANT SIGNATURE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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
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 Pe
14.50
.50 ' $"0
S7J,Od
PLUMBING PERMIT FEE $
ST ATE SURCHARGE $
TOT AL PERMIT FEE $
Paid 50, () 0
Date4-, 'i..tJ Y
(Office Use Only)
This Application Becomes Your Building Permit When Approved
No. 555'~ d
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714