HomeMy WebLinkAboutPlumbing 07-0441
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~Dc.;.; CITY OF PRIOR LAKE PLUMBING PERMIT
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Date Rec'd
; ~~ ~I~ I PERMIT NO. 07, OAJLI I
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ZONING (office use)
LOT
BLOCK
ADDITION
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LEGAL DESCRIPTION (office use only)
(Contact Person)
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OWNER
(Name)
(Address)
APPLICANT
(Name)
(Phone)
(Address)
(Address)
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(Phone)
APPLICANT SIGNATURE
DATE
AP'PLICANT 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 A'est ~
Bar Sink .x Lawn Sprinkler -fJVf)xl
Water Closet (Toilet) . Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $9950
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 1-(1" C/l)
Date / (, ,
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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