HomeMy WebLinkAboutPlumbing Permit 09-0043
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO.Oq. oo~J3
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
~d \ev
Blind {{ fr ffCiI /
(Address)
APPLICANT
(Name)
Champion
651-365-1340
3670 Dodd Rd. #100
(Address) Eagan. MN 55123-1339
(Contact Person) Jr ') ~ 0 te/0
(Address)
APPLICANT SIGNATURE
(Phone)
9~ Dl) ft) - (pC(j}
(Phone)
(City)
(Zip Code)
(Phone)
DATE
APPL CANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher i Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildine: Official
Date
Building Permit #
$ ----b/q. 50
$ .50
$ 0"' 0'"
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pai~O , (/iJ
Datze s-
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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