HomeMy WebLinkAboutPlumbing 08-0185
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
; ~~ ~:~ I PERMIT NO. 012. O/t2 -l
3_ Yellow Applicant , (;) 1I bJ
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
&ad I e<j ~^^; +emU
SClm e
(Phone)
5S3
C\S "l-t-{c.fty r~c-t;
~
(Address)
APPLICANT
(Name)
APPLICANT SIGNATURE
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
DATE
4- - I ~ -oe
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 $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ ~q. So
$ .50
$ ~tJ UJ
-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 50. <fO
Date ()IL
.z,z,. 0
By
No, 5.>.r--q
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
"31010
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