HomeMy WebLinkAboutPlumbing Permit 07-0566
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO I
2. Gold City . 0-"1 _ 051 {~
3. Yellow Applicant , I \.0\(1,
ZONING (office use)
ADDRESif j111
.>3sv'
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-. 4"?7 _ 07Cf.O
2=T~~
I OWNER
(Name)
(Address)
(Phone)
APPLICANT
(Name)
MINNETONKA, MN 55345
(952) 93~.7200
(Phone)
(Address)
APPLICANT SIGNATURE
(Zip Code)
(Contact Person)
DATE
Ci Lz{ /d/l
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain J 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 $ of..(Jf - Building Permit #
.39.57)
n .50
~-oj
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid
ptNo. 54'0 7
Building Official
24Jtournotic~ fo(alI inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Av.e., S.E., Prior Lake, MN 55372-1714
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