HomeMy WebLinkAboutPlumbing Permit 07. 0727 0 00000 0 i o > zo
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o� Ire/ ° Date Rec'd
U (� x CITY OF PRIOR LAKE PLUMBING PERMIT 6 1 en
14 Nxeso lr
z Gold File PERMIT N O. �
City
3 Yellow Applicant a� - 1,2,1
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(Please type or print and sign at bottom)
ADDRESS C) ZONING (otfiiceuse)
38 91 s 77 0AI PL c Aj,i/
:� c, Pd.ro
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION V PE . PO/J -0 3 ' PID 2.-5. 463 C` 1 a
OWNER
(Name) (Phone)
(Address)
APPLICANT
(Name) 60 RA/4A/ (Phone) 76,7. t DO 0
(Address) ZZa O W . may. 13 3 v/.&6 55'337
(Address) (City) (Zip Code)
(Contact Person) t/ (Phone) 74 7• /0 U 0
APPLICANT SIGNATURE 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 (I 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 $ Building Permit #
PLUMBING PERMIT FEE $ 3 9:- ov
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4 0 0
(Office Use Only)
This Ap. i.. i. ecomes Your B uilding Perm' W n Approved Paid 0 , c . 7 R'c ipt No. ......
AIL - . I� CJ L Date y
Buildin Official " ,, Da e 6 le r 07
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372 -1714