HomeMy WebLinkAboutPlumbing Permit 09-0693
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1. Blue File
2. Gold City
3. Yellow Applicant
\ PERMITNO'Oq. Oe:,f-$
ZONING (office use)
Five HfLWJ<S 7fvL.-SE
LEGAL DESCRIPTION (office use only)
PID
LOT
BLOCK
ADDITION
(Address)
(Phone) J2J 2.- 9 t '=> 25 Cj 3
OWNE~
(Name) Off P...n
APPLICANT SIGNATURE
(Phone) ~c:s (~3G::6- l540
f(t~:rJ.f") M N 5511..3
(City (Zip Code)
(Phone) ~\-~~.-\6~O
-01
DATE
APPLlCANTr . i2J b'
~ame) ~t~'(~J
(Address) ~
(Address)
(Contact Person)
Quanti
APPLICANT PLEASE COMPLETE BELOW
T e of Fixture Quanti
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavato Bathroom Sink
Laund Tra 1 or 2 com artment sink
Shower Stall
Sinks
Bar Sink
Water Closet
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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Lf<1 ,50
.50
~D I 00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paidsv. crv
Date
Receipt NOse 77
Date
BuUdinl! Official
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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