HomeMy WebLinkAboutPlumbing 08-0484
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~. ~~~ ~!:~y I PERMIT NO. 08.04-8/1 1
3. Yellow Applicant , ~
rint and si n at bottom)
ADDRESS "- ZONING (office use)
4DuC) ~~wwd~l'~
LOT
BLOCK
ADDITION
PID
I
d75~
LEGAL DESCRIPTION (office use only)
&'::R p~ HlAns/na~r-
(Address) LiO () 6vzu.yu;1w c-L T ~
~:::;~~ANTVoYt2lOWJ ~01~
(Address~q05 6uvnill :k.~ ~ .
(Address)
(ContactP,,",on) ~
APPLICANT SIGNAT~ ~ -----v'-- - DATE
APPLICANT PLEASE COMPLETE BELOW
(Phone) Q'5d' C)..t).lp.
6f5 3/ Vc....
(Phone) (Q/~' 2~ 7 ~ t-/o3 ~
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(Phone) W;)- L/ss- (] c, --, 7
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Quantity Type of Fixture Quantity Tvpe of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray ( I or 2 compartment sink Sewage Eiector
Shower Stall Backflow Assembly
Sinks Backflow Assemblv Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
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 $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
#.SV 0
060. 0
Buildinl! Official
Date
Paid SO, (; ()
Date -7"" I b, e,J
o. 510]4'1
(Office Use Only)
I 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