HomeMy WebLinkAboutBUILDING 07-0780
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(Xi> CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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1- Blue File I PERM 0 ::J
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ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER D
(Name) __ 1 f'~t L/
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(Phone) 6I/- 47;)- a:.J 7'-/
(Address)
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APPLICANT j/2 1')} b
(Name) L( _ ~I ~ _ JX/ 1"1
31b69 ;&/.5-T /JPe
(Address)
(Contact Person) ----.X.(J (/ I ~
(Address)
(Phone) b/ J- .:Q8'- ?~a&
M4.J f{47~ IYJtV Sot)?/
(City) (Zip Code)
(Phone) b I;).. - :5 d. tf'- 7 fO f(
I APPLICANT SIGNATURE
DATE
PLEASE COMPLETE BELOW
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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 Eiector
Shower Stall I Backtlow Assembly fiJl! (e:..,.../ v S
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
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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 $ ;0 () f!!!- Building Permit # .
PLUMBING PERMIT FEE $ 3Q..> to?
STATE SURCHARGE $
TOTAL PERMIT FEE $
~ .50
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(Office LIse Only)
Buildin!! Official
Date
Paid +-O~(J 0
Date 8~ ((,,.CJ
tNo. 6fS5S
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714