HomeMy WebLinkAboutPlumbing Permit 09-0415
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(,. ~z--'o 7
1. Blue Fik I PERMIT NO n I
2. Gold City . 07, 04/r-
3. Yellow Applicant ~
ZONING (office use)
saiior] PI ac ~ Nw
LEGAL DESCRIPTION (office use only)
LOT
BLOCK ......-' ADDITION
PID
OWNER w.' l"
(Name) ({ (WVY1
Fr/n [-0
DrLa.jL~
(Phone) q 5' J. - 2255- (jkS f
;tAt\!. 515371-
APPLICANT
(Name)
Champion
65 1-355- 1340
3670 Dodd Rd. #100
E~X~'r~m 55 123- 1339
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
Quanti
LICANT PLEASE COMPLETE BELOW
T e of Fixture Quantit
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavato Bathroom Sink
Laund Tra (lor 2 com artment sink
Shower Stall
Sinks
Bar Sink
Water Closet
(Phone)
APPLICANT SIGNATURE
DATE
. -1 ?-O
e of Fixture
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 $
Building Permit #
$~
$ .50
$ SO- 00
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
Buildinl! Official
Date
Paid sv. U{)
Date (,. z, z, C/
o. S8Ufp
This Application Becomes Your Building Permit When Approved
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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