HomeMy WebLinkAboutPlumbing Permit 09. 0184 4 PRIp J� Date Rec'd
,, tl CITY OF PRIOR LAKE PLUMBING PERMIT �/
41/ NNES V
1. Blue File PERMIT NO . U
2. Yel City / y / Q
3. Yellow Applicant V � (�
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/7472 SW)ray Card- LW
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(NaWNER V e S Sj C 4 f CI U /Pi (Phone) (05i I 6S
(Address) (...3a/Me, 1 Iri or 1/Wze( N . ✓ 537 2
APPLICANT
(Name) Champion (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd. #100
( iis N 55123 -1339 (City) (Zip Code)
(Contact Person) , _ ~ S J (Phone)
APPLICANT SIGNATURE ,r�°' ' , µ DATE _____Q _
APPLICANT PLEASE COMPLETE BELOW F
Quantity, Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher f 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 $ Building Permit #
PLUMBING PERMIT FEE $ `T 1 .5 O
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ L 1(9,00
(Office Use Only)
1
This Application Becomes Your Building Permit When Approved Paid 6 (/2.) Receip o.
Date ¢ Z U By
Buildine Official Date /' /
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 ��
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 Lb