HomeMy WebLinkAboutBuilding Permit 08. 0751 •
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9 CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO . R
3 Geld City O 07 /
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(035-C -- 4na \ 6 rd \Jci
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER n f
(Name) \ .'� ` . x{�.'� k�e ( Phone ) SP, -- , `"1 (p O/
(Address) \ 6 d 5(X, l.))01
APPLICANT A ( U _
(Name) . ` .r(� ()C \f 0.M,e. kk C l \.&XL* T (Phone) � ( — - 3S(0-&(0 - 1
(Address) 3' I A4 'fir r i VL' V SO / W-4— 9 Ro
(Addy s) (City) (Zip Code)
(Contact Person) ' II • r 0 ' (Phone) — 1 t 5 -3g ( - (00(01
APPLICANT SIGNATURE A I 1 DATE
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 Softner
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 $39.50 minimum Residential, New One & Two - Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ 1p0,0 -O Building Permit #
PLUMBING PERMIT FEE $ 3Q .
STATE SURCHARGE $ .50
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid U0 Rec: p b.S7
Date 9 ZL By
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 /
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372 -1714