HomeMy WebLinkAboutPlumbing Permit 09. 0113 J ili
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VRIO Date Rec'd
0 CITY OF PRIOR LAKE PLUMBING PERMIT
73 *
iivNEso t
t. Blue ie PERMIT NO. f
2. Gold oId City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
p.3 Witcf 004 j ecC--.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIDZ -& 4- 1 '0
OWNER
(Name) (Phone)
(Address)
APPLICANT �,
(Name) 1'� -1 $ �� OIL U n '\SV 1 1 (Phone)
(Address) - 2 P pZO 5 T 'j t • 2r kit WG-P- /NV\, sS 3 If
(Address) (City) (Zip Code)
!-
(Contact Person) �`� (Phone) g5 " �� 2-- O �S
APPLICANT SIGNATURE
A ¢ - 1 DATE - 5 - ( 5 ' 7
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
c.,-." /� c.,-." Estimated Cost $ i / -. 5 Building Permit #
PLUMBING PERMIT FEE $ 4'T. , -''
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ S '-
(Office Use Ji Iy
Y-
This •p jli, , ion Becomes Your Building Per it When
1 Approved Paid +c^0` '^ Receipt No. $-7 Z
C. L7 Date 7 By (Zit)
B ldine Official ate k I
/ 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372