HomeMy WebLinkAboutPlumbing 07-0242
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
ADDRESS
Ir:,~
at bottom)
~. ~~ ~:~ I PERMIT NO. 0-1 (jZ~71
3_ Yellow Applicant . ( " {/ .
~dge~Cht- .1tve6~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID I~. () 54-. 0030
OWNER (1h"/I~~
(Name)~~
(Address)~. . - .' or
~;~~~~~O(IU
(Address) ~~-=xd d
., (Address)
(Contact Person) Y-r I ~ Ci e
.<\PPLICANT SIGNATURE
Laxi.t ~.
(Phone) 95~ -'-/L(/7 - ;) 708
c:h?:/7~
J2c1.
(PhO~~-<2S. b5'-I~O
~~? Jv1N tJ)J 3
. ( Y) . (Zip Code)
(Phone) :>f-,3h5-/5l/0
4- h-D'
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher f 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
Estimated Cost $ dO 0 . U 0
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
(Office Use Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3q5D
.50
LJiJ. VO
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4-<>.00
Date tL.
T.')<) .
ce'tNO'S3+o4-
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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