HomeMy WebLinkAboutPlumbing 07-0669
Date Rec'd
J. Blue File PERMIT NO
2 Gold City . () 7. 0 / /
3 Yellow Applicant - ~ (c;;
at bottom)
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
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13 UTL€Jt.
15 LlA.E:5 i rt,O
(Phone)
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APPLICANj; ,
(Name) rtLt;~ (II ~/t-J..5
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(Address) ~ LoU c l. ~ ow "-.:) 00 p sr .
(Address)
(Contact Person) -::I:)~ Cl.O~, ~
APPLICANT SIGNATURE
(Phone) e I 'Z. -(/1' J -''Z. ,,~
Prti 0'- g-'! 7 -z,
(City) (Zip Code)
(Phone) ~12 - Ltd'3 - q 2.. 'f?
DATE
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 'y Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
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 $
3~. 50
.50
4d, 0 ()
(Office Use Only)
This Application Becomes Your Building Permit When Approved
~~
Paid
Receipt NO'SttZfcJ
By
Building Official
7/~slo7
Date
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714