HomeMy WebLinkAboutPlumbing 07-0806
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~. U.Ol
I. Blue File
2. Gold City
3_ Yellow Applicant
I PERMIT NO. 07 . O~ oed
I
ZONING (office use)
at bottom)
ed'{{;(vvood St. Nt:-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID t5. Z.3~ . DC f. 0
OWNER .
(Name) ~\ Vv _
(Address)
,:c.bnSQ ~" . .'. (Phon~'3 J- 23Cj- 'S'S}cj
(d)( lu~Ke. MN. 5~~1
(Address)
651-365-1340
3670 Dodd Rd #100
Eagan. MN 55123-1339
(Phone)
APPLICANT
(Name)
(City)
(Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
~ - (p- 0 I
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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
ipt No. 64'.("1
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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