HomeMy WebLinkAboutPlumbing Permit 11-0025 - , . �wwa.� F
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4 pRip Date Rec'd
� �� CITY OF PRIOR LAKE PLUMBING PERMIT
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�. B�ue File pERMIT NO. b Q
2. co�a ciry
3. Yellow Applicant �
lease or ' t and si at bottom
ADDRESS � � _ . . ^� S � � � � ZONING (os'ice use)
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LEGAL DESCRIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID aj .. ��, ��Z yb
�WmiER � a�jl l � �/l f `-Y l �/Y1�111 (Phone) �� U �� �� ��
(Address) � � � / V �(,�{��.� �
(Name) �T A�hliance Conra �.'�C�i0i1S 0i1C (phone)
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(Address) ' �
� -�rJ-4: ' ,: (Cih') (Zip Code)
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(Conta.ct Person) (Phone)
APPLICANT SIGNATURE DATE �� ` l I
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fizture Quanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e ashin Machine
Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
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 $ � "' � Building Pertnit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid C r71 Receip o�/!� ��
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Date ( � By
Buildin¢ Offfcial Date • '
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372