HomeMy WebLinkAboutPlumbing Permit 11-0060 PR1 Date Rec'd '/.9,//
°� 4 ' C ITY OF PRIOR LAKE PLUMBING PERMIT
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' Blue File PERMIT NO. V
z. cola city
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 4 .50 i(QCD -I
LEG DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER Y J (� t
(Name) b I `�c� co 6,.. ` t (Phone)
(Address)
(Name) ANT SKI �� w: y P l w.. Li. ev e j.,--,,,./ (Phone) Co 7 .�2 6 3 OR/1
(Address) 1 , V3 I l - ft- vt- v" w44.A‘S0 5
(Address) (City) (Zip Code)
(Contact Person) \ (Phone) /
APPLICANT SIGNATURE <��+ '3�— DATE � ! (-' / /
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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 Softener
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 $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
1
This Application Becomes Your Building Permit When Approved Paid , `T / S (/�G Receipt o. i 7 n3 �
-�
Date By
Building Official Date 1- 14' (
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372