HomeMy WebLinkAboutPlumbing Permit 07-0411
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
5, z..qol
I. Blue File
2 Gold Clty
3 Yellow Applicanl
I PERMIT NO. Ol 04/ /
I
ZONING (office use)
~;;~~:=d"""Ubotto:
I / Lf34 ,73J, '.(')"/y=/;;U-- (]';rr::. /-(';
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-. 3ei G. (101,6
OWNER
(Name)
W.rn IJl7 nLJACj
f9'5d)?3~ ?-75~
(Phone) .c:.. . - S r
(Address)
.-J
APPLICANT I / . hi / _
(Name) ,:4 /-Iarlf;- ~ r/l1 L//L!. (Phonel~~2 ) L/L/rJ.3 77et
(Address) /~21Y() /J 7~LSh'ffLtJn /]{)ALV H/cJr LAIAe. 55372-
(Address) (City) (Zip Code)
(Contact Person) ~i7 ~c-17/AJ ~ (Phone) .-e...K'-f- :2 '2-3>
APPLICANT SIGNATURE ~l?tf/~d~// DATE ,~/Tt:J7.
./
APPLICANT PLEASE COMPLETE BELOW
i
I
I
~
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 I Lawn Sprinkler
Water Closet (Toilet) 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 $
3c;.SD
.50
4D.oO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 40.00
Date 5. Z 9. 07
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
16200 Ea2\e Creek Ave., S,E., Prior Lake, MN 55372-1714