HomeMy WebLinkAboutPlumbing 07-0024
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
/./ft.07
~.:~ ~:~ I PERMIT NO.O?,. OozAL
3 Yellow Applicant , _:::r:r-
ZONING (office use)
LaA~.e s I de A-v €./ S' t:..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
PaJ- J,fc fMdeh
s~
PriD( La..k.e ( M N'
(Phone) q5a 'lfc{.7~ 3 Cji) J
.I
553 7 J
(Address)
(Phone)
(Phone)
APPLICANT J+p
(N ame)
(Address) ~ 70
fJ'
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
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 (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 $ ;)00.00
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
J0~ ')0
.50
1-/0, DO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid , 0
+cL
oat u,.
By
o. 5Z-'Z 7
.
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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