HomeMy WebLinkAboutPlumbing 07-0323
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO =?2l
i ~:~w ~~~Iicant . 07 . 0:5 L.....-1
ZONING (office use)
3~~l
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s.w.
'ffiN 5S 1
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDl.5"". 442..02.-0.0
OWNE~
(Name)
DATE
(Address)
APPLIC~ C '
(Name) .. fro I
(Address) 5, ~ Q,
(Contact Person)
APPLICANT SIGNATURE
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 J 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 $ J 0 O. D 0
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
?ll . CD
.50
40- OD
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid 4-0, 00
Date ~/4-. 0
Receipt No.
Building Official
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714