HomeMy WebLinkAboutPlumbing 07-1112
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or Print and si~ at bottom)
ADDRESS ZONING (office use)
I. Blue File PERMIT NO
2 Gold City . 0 7 _ I / I 2-
3. Yellow Applicant _
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
1<0 re VI
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(Phone) 95 ci - l.{ 4 5 - ;J. I () L/
(Address)
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~'I \1.5 C1 N{
(City)
APPLICANT
(Name)
CULLIGAN WATER CONDITIONING
6030 cttLLlG';N-WAY
M1NNETONKA, MN 55345
(Address) (95,~) ~k3j'l ;;:1)0
(Phone)
(Address)
(Contact Person) (Phone)
'PLICANTSIGNATIJRE ~ 2",~ DATE JD- 2J."J- 07
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower i Rough-ins
Dishwasher I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) I Other
I
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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 $ ~ DD I t)O
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3'L 50
.50
4t) l () ()
(Office Use Only)
~his Application Becomes Your Building Permit When Approved
24 hour II
1620
Paid AO
#1, ..,IV
"n'. I Date I L {it .(, 7
City of Prior Lake Bldg. Dept.
4646 Dakota Street Southeast 147-4245
Prior Lake, Minnesota 55372 714
Phone: 952,447.9850
FAX: 952,447,4245
RetJpt NO.:>---r' 0 ~ L-
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Building Official