HomeMy WebLinkAboutPlumbing Permit 13. 0443 Z
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i" :1 0 , CITY OF PRIOR LAKE PLUMBING PERMIT
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PERMIT NO. � .2„, o ? L Ftle
Yellow Applicant
(Please type or print and sign at bottom) V ->
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only) �`/
LOT / B LOCK / ADDITION �'IbR 2'VA/ i A) p LIM - 7/,? - 0
OWNER /,
(Name) t� "^ (Phone) 'd r?.3 ".?"6.?
(Address) ar C7744.tkit_Ai -SA &
APPLICAN r _ / p joar-
(Name) ?a. �, (Pho ne) 411-4011
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(Address) e&trZ dt1Qktil l /I� . 4✓ d�( y11 Ir 53
(Address) (City) (Zip Code)
(Contact Person) C ,� / _ (Phone) /2 �
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APPLICANT SIGNATURE 11 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 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 $ 66 Building Permit #
PLUMBING PERMIT FEE $ 4 /9-9
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved ' ` sJ Receipt No. t 9o
Buildine Official Date D , /( 7 By
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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