HomeMy WebLinkAboutPlumbing Permit 07-1174
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Date Rec'd
CITY OF PRIOR LAKE PLUM"pT'","C' PERMIT
k.~
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5537 ~
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n' fL,'"...1 NO. 07 -1"'1 i
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I ADDRESS
9 () 0 ~ r\ \1\5
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZG. 133.D . ~
OWNER
(Name)
(Address)
S ..\ e. \J"L
~9DO
(Phone)
APPLICANT
(Name) CUll IGAN WATER CONDlTlONfNG
6030 CULLIGAN WAY
(Address) MINNETONKA, MN 55345 '
{M2f9a3-7200
(Phone)
(Contact Person)
(City)
(Phone)
(Zip Code)
APPLICANT SIGNATURE
DATE
1;).-1- 61
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain I 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 Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ d DO. 0 CJ
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39,50
.50
~D I DO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 40. <.IV
~_._ Date ',&./ q .O{
Building Official
City of Prior Lake Bldg. Dept.
24 hour m 4646 Dakota Street Southeast 17-4245
16200 Prior Lake, Minnesota 55372 '14
Phone: 952.447.9850
FAX: 952.447.4245