HomeMy WebLinkAboutPlumbing Permit 09-0363
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO. 09, 03 '-.31
(Please type or print and sign at bottom)
I ADDRESS 4ltlt~ ~W~OO~ ~,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
t~\1Y\-e, lknY\ln
L.-\\tlt~ ~(),~ood ·
(Phone) ~~.4LtD. ~
(Address)
APPLICANT
(Name)
(Contact Person)
Appliance Conr"~ctiDn&)lnc
1313 Danita Cr
Shakopee, MN 5~
952-445-4803
(Phone)
(Zip Code)
(Address)
(Address)
APPLICANT SIGNATURE
DATE
4.\~JOf
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rou~h-ins
Dishwasher \ Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewa~e Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
49.50
-f- .50
L5l) df)
(Office Use Only)
Buildill2 Official
Date
Paid 50 . (J[)
Date(p . / 2. , 0
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