HomeMy WebLinkAboutPlumbing Permit 07-1111
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
~. ~~~ ~~~ I PERMIT NO. rr-7. I 'I J. I
3 Yellow Applicant , V (. LU--J
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
Jd O-vo l~ Ro.. \ no{' S
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(Phone) 95 d - l/l/ 5 - 6 b I V
(Address)
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APPLICANT
(Name)
l. . '..;1
6030 CULLIGAN WAY
MINNETONKA, MN 55345
(952) 933..7200
'. r,"''''''',. ?,iI' :.' -,
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
PPLICANT SIGNATURE
(Phone)
DATE
lO-d.~-DI
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 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ rJ () o. 0 0
Building Pennit #
(Office Use Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Building Official
Paid I uv
Date fl. t L' . c7
City of Prior Lake Bldg. Dept
4646 Dakota Street Southeast
Prior Lake, Minnesota 55372
Phone: 952.447.9850
FAX: 952.447.4245
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"his Application Becomes Your Building Permit When Approved
24 hour not
16200
7-4245
14