HomeMy WebLinkAboutPlumbing Permit 09-0022 (2) p RIO Date Rec'd
� CITY OF PRIOR LAKE PLUMBING PERMIT
,
/- / 5 - cl
lANES0 1. Blue File
2. Gold City PERMIT NO. 00
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS SS 3 7 ZONING (office use)
1 L i - 6 (,•) . I dJ Pk A V
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) t/\, L U C S � ►' � c / �3 TDdd (Phone) 91a ` / ` , ? - 793
(Address) 1 T6a`i ( > kb CCW V
APPLICANT CULLIGAN WATER CONDITIONING
(Name) 6030 CULLIGAN WAY (Phone)
MINNETONKA. MN 55345
(Address) (Addr42) 933 7200 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE ../ _t___ DATE _c;)' c)-3 - 0 0
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 $ 9 Building Permit #
PLUMBING PERMIT FEE $ 4-1,3m0
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ . 0
(Office Use Only)
I
This Application Becomes Your Building Permit When Approved Paid V �� O T Recei � o. 70 0 7
Dat / 4-- U 7 B y .
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 i
4646 Dakota Street S.E., Prior Lake, Minnesota 55372