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ti CITY OF PRIOR LAKE PLUMBING PERMIT
- `�'NESO��
1. slue File PERMIT NO
2. Yell City . p D 2 .5 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office
LOT 2 BLOCK 11 TRAILHEAD ALL UNITS IRRIGATION LSe) Push
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EGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 0....S 4& . 04 /_ O
OWNER
(Name) WENSMANN HOMES (Phone)
(Address) 1895 PLAZA DRIVE STE 22 EAGAN, MN 55122
APPLICANT
(Name) GENZ -RYAN (Phone) 952- 767 -1000
(Address) 2200 W HWY 13 BURNSVILLE 55337
(Address) (City) (Zip Code)
(Contact Person) KIM RENVILLE (Phone) 952
APPLICANT SIGNATURE �r /L / /. . 1 / DATE 7/17/07
• ICANT 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 (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks _ Backflow Assembly Test
Bar Sink — yr 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 $ 39.50
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 40.00
(Office Use Only)
This App 1I n/' • com JYogr Building Per ' WNen Approved Paid 4_ t rl � Re pt No. ���
I iii'.. _ 3' 6/c9
7 Date ' , 1:3))
Official Date Z) ° 0 '
6 •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372 -1714