HomeMy WebLinkAboutPlumbing 08-0224
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Ye\low Applicant
_ .J
I PERMIT NO. '6y 224-1
(Pk~ ~ m ....t md "SO" bottom)
I ADDRESS
'03 \ \, ?c~:< \'-
..
ZONING (office use)
k
Sf
.55 :!:> 7 ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
R \ c..\"\
\\:;3
.po'W~ .s
t'CA.f'k k
(Phone) ~5j . <655 - Y 350
APPLICANT
(Name)
(Address)
CULLIGAN WATER CONDITIONING
5030 CULLIGAN WAY
MINNerONKA, MN 55345
(Addi.es~52) 933-7200 _
(Phone)
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
l\-/5.bR
Quantity Tvoe of Fixture Quantity Tvoe of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain I Water Softener
Lavatorv (Bathroom Sink) Stand Pipe (Washing Machine)
Laundrv Tray (lor 2 compartment sink Sewage Eiector
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 $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ d. 00 . Db
Building Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Ljq,SD
.50
50, au
(Office Use Only)
Buildine Official
Date
Paid -50- t/LJ
Date4.) o,u/
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372