HomeMy WebLinkAboutBuilding Permit 10. 0004 •
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( ...),,v, R10 Date Rec'd
i ce CITY OF PRIOR LAKE PLUMBING PERMIT 5-, 0
41IA'NEsOrC 1. Blue File
2. Gold City PERMIT NO. /� Q bb�
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 5 h aSSiVoc 1 6 t (' V V
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( 0 1va WNER
C hcu Cn / / / J e'e <) (Phone) Lo/ 2 ~ 7 / � 2l
(Address) c J 1 l / / o
APPLICANT „ C P/w I I Kw
(Address) 1197 0 /2OciCI gd- ..t /jar f J ( ' 5512 3
(Address) ity) (Zip Code) ,...,
(Contact Person) �. tea- U ,J (Phone)51 — . LijS ----/
APPLICANT SIGNATURE ,r --11 DATE — 30 — O__7_____
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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
r Residential, Additions & Alterations $49.50
Estimated Cost $ goo Building Permit #
PLUMBING PERMIT FEE $ 4 • 5
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 50 „ 06
(Office Use Only)
1
This Application Becomes Your Building Permit When Approved Paid5b G,U Rece o.5-935
Date A �-
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 )9`