HomeMy WebLinkAboutBuilding Permit 08. 0628 J
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4 P R Ip Date Rec'd
,.. °`e CITY OF PRIOR LAKE PLUMBING PERMIT
ti fiNNEso t-
1 . Blue File
2 Gold City PERMIT NO.O U ei
.
3. Yellow Applicant �
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ y C'435 lAi /lots P
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) LC1,US T (phone) 934 — 0 105
(Address) 1 I t 3 S V v 1 L k S P 1\k i6
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APPLICANT V5 ertAil--1(31.- . II ^^ L n r �� C 1 � - , -" 16 -
(Name) , 1110 Jv j< yCJ�
(Address) a (Phone) Wt� o U `l
l -Q- ' • U- ` _ 5S
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(Address) (City) (Zip Code)
(Contact Person) ci CLUJ L (Phone) (Lt I a-, 1 -165 Oct
— 7
APPLICANT SIGNATURE I DATE C) 6 I°
/__
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
�(( Residential, Additions & Alterations $49.50
Estimated Cost $ 4 0D Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ lib
(Office Use Only)
1
This Application Becomes Your Building Permit When Approved PaidS U U Receipt No. L - 7 3 - e p
Building Official Date Date ' Z O 0 & By ,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372