HomeMy WebLinkAboutPlumbing Permit 13. 0772 J
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
NESO �� ]. Blue File
2. Gold City PERMIT NO. .3 _ (f 77)
3. Yellow Applicant N
(Please type or print and sign at bottom)
ADDRESS ( br CIr6( ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) R Ku( A actO kl t V k (Phone)67 15(0 3
(Address) Sj fr(Jk5 C mf P. (sE
APPLICANT `� + ('� ,/� ! D / � � �� f /
(Name) TC ∎ `J p I tQ 1 CC, (Phone) q -- l�(c 5 ~ �('
(Address) oo (OuaI MA qi V V . lL / 6 3 3 1
(Address) (C (Zip Code)
(Contact Person) t' • 1% L b ( Phone) q-
APPLICANT SIGNATURE DATE C VIVO
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 I 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 -Famil $149.50
R ' n to , Additions & Alterations
Estimated Cost $ 11, '✓ V Building Permit #
PLUMBING PERMIT FEE $ 'f `l. 5
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ o 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid oQ Receipt Not 9 79
Date /// 7/� � By
Buildine Official Date C
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
A c, t mr s B ,v; ,, '".745■400; n;'q'`r', y -� x jsATiirb FFMMT`, . 91,7' `r 11.T',P T "'k5¢►f :er "7',17.4 Y