HomeMy WebLinkAboutPlumbing Permit #12-554 J
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� pRl Date Rec'd
� �� CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File ����rT. �7�
2. Gold City 1 l, � 2.�5 �
3. Yellow Applicant
Please e or rint and si at bottom
ADDRESS ZONING (oflFice use)
..��� .��.��"� t.� Gr� l�
LEGAL DESCR�TION (of�ice use only)
LOT BLOCK ADDITION PID
o�R 2 - 25
(Name) � � (Phone) � '� � I
(Address) ��-� �(� (� �;{'� � . �� J / c�
APPLICAN � f � l — L �
(Name) (Phone)
(Address) V ' ��
( ddress) City) (Zip Code)
(Contact Person) � (Phone)
APPLICANT SIGNATURE DATE — � �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti 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
Laun 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 Permit #
PLUMBING PERMIT FEE $ � �
STATE SURCHARGE $ 5. O
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Re e pt No /, I
V
Dat ` By
Buildine Official Date o � •
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 ,� ,^
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ` j��