HomeMy WebLinkAboutPLUMBING 06-0506
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(P. /Z. ()(P
I Blue File PERMIT NO
2, Gold City . /1/. 0 So /
3. Yellow Applicant Vv to
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ADDRESS ZONING (office use)
~/O )/ct~ 0-'*' $
(Contact Person) , II (Phone)
.\PPLICANT SIGNA TURE__~.uIItA, 1u./ DATE _ ~. a . ty ,
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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(Address)
APPLICANT
(Name)
(Address)
(Address)
Quantity
PID Z. r. r; J'. d z..,.. 0
(Phone) ~l. 4 '-11. ~
(Phone) {A2-ql98 - )"eCc>
(City)
(Zip Code)
Type of Fixture
-.,i--
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
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
39- .ro
.50
4tJ,vCJ
Paid 4--0. nI
Date ~ ./Z-. "f:,
Receipt No. 5/57:1
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714