HomeMy WebLinkAboutPlumbing 08-0395
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
lm Cj Yili
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER .c:::; /1 ~"
(Name) Dr l Vl ,I EOVl
(Address) &~ Cl& & r+e
~~~;~~~0}UW1 P\;u.w1lol
(Add",,) d-.q Os Go.Jfulul +; ~ ~
(Address) ,
(Contact Person) J~
~. ~~~ ~~:y I PERMIT NO. () Q. . 0' 70 ~
3 Yellow Applicant C/ _ ~,lQJ
vJ
ZONING (office use)
(Phone) C~d-6 )4qa --
(}-.I COg'
APPLICANT SIGNATURE
(Phone) j 1Ql ~) C(:J-7 -L-J D3-5
~Lo 5~~~~)
(Phone) LLQJ d- ) ~;} 7'~4063
(31.1 6
DATE
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 Sinlk Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
IndustriaL Commercial & Multi-family 1% ofjoh cost with a $39.50 minimum
Estimated Cost $
Residential, New One & Two-Family $99.50
ResidentiaL Additions & Alterations $J!SlF
'fqc:e-
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office lJse Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
LfCi .11
.50
50.@
paid3~. (;lJ}
Dati. f;. Oe
eipt NO.~3 0
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714