HomeMy WebLinkAboutPlumbing Permit 11-0061 o� plO�f' Date Rec'd
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2 . Blue Gold C cie ity PERMIT NO/ / 6
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S L i 3 l i� � Sr
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER `! -cul 6.1 $
ame) (Phone)
(Address)
PLICANT T- D " ' 41,4 .1 ' L (Phone) 5 ).(2-3 s � `/
(Name) W ` ""
(Address) 3 3 3 (i ' S t` '' f9-tlk .,wl Sow S /6
(Address) (City) (Zip Code)
6
(Contact Person) (Phone)
APPLICANT SIGNATURE AZIA DATE 1716 ,
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 Assemb y s
Bar Sink Lawn Sprinkler A ` `
Water Closet (Toilet) Other 4 7,
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)
This Application Becomes Your Building Permit When Approved 1 Paid D Rece No. / 4 2 z___
Da
Buildine Official Date � B
2,4 , /I
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372