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CITY OF PRIOR LAKE PLUMBING PERMIT
v
I. Glue File PERMIT NO. A3 /7 2 Gold City !�—�
3. Yellow Applicant
ease type or and s at bottom)
ADDRESS ZONING (office use)
r / Z +SCa apt S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
e l:a 4 :-. 11- - -) 1 <t i4) (Phone) q3) a s ip Lico b i
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone)
AP ICANT SIGNATURE �____ 2
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 //aj Z.l /l e-
X4
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 $ 410 SO
STATE SURCHARGE $ *0
TOTAL PERMIT FEE $ MO
(Office Use Only) /
This Applicat,1 1 % ecomes Your Building Permit When Approved Paid 2) Rece'. No. 68 8 4 ^ /
i ,► 3 4 • (3 Date l / By
Build fl 7 ial Date ( / '
I 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372