HomeMy WebLinkAboutPlumbing Permit 10. 0579 J
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61
of PRl o p Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
to, 30 la
` t N E5 0
1. Blue File PERMIT NO . p
2. Gold City /C. 7
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14-0 0 it/ass /fl
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /� / (J ,/
(Name) 9f �i ,� t/�[ & ( Phone ) q '/4
(Address) /4070 ✓ i sc &/ r- (J / / /L,A/ �27
APPLICANT
(Name)Mfa 82 ' q l/ W ) / -
/�l 0a2 PB P/1�,249in "t e / /
(Address) Pa. / _ / / 1
(Address) (City) (Zip Code)
(Contact Person) II . .4 1 ,� J/_ (Phone) _.
APPLICANT SIGNATURE ,�)� DATE - 3
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
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 $ ('O0. Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ . 7 ,
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid cam Rece No. U f'Y
Date
Building Official Date CO- 30, f U B
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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