HomeMy WebLinkAboutPlumbing Permit 07-0812 o F pR�o,p Date Rec'd
,� D� CITY OF PRIOR LAKE PLUMBING PERMIT �J, 2Z. �
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�. B�°° F��° pERMIT NO.
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3 Yellow Applicant • � O � � �
lease or rint and ' at bottom
ADDRESS � � ? � / ZONING (oft'ice use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PI
OWNER
(Name)
(Address) a
APPLICANT
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::. �. � Z Z I o.�� wo � o �l,.t i'v E. �rse� o, r�?rV SS 33v
(Address) (Cityj T (Zip Code)
"`� � i� / G EDG T (Phone) ?C• 3'Z y 1'/ 3 Z o �
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APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
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$39.50 minimum Residenrial, New One 8c Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Permit #
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PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid /�' Re ip No. �'
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Date D By
Building Ofticial Date �/ Z��� y
24 hour ootice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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