HomeMy WebLinkAboutPlumbing Permit 13. 0241 Oi ?Rip /a ' ///0 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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Applicant T
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ADDRESS ZONING (office use)
-3 7 Po, n . Pass Pass d n 3 �a
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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( N a m e ) 2-Q a\ 1" \ 1 1 + 1 p S (Phone) C c 1 a- 9 C 3- s 7 7)
(Address)
APPLICANT
(Name) CULLIGAN WATER CONDITIONING (Phone)
6030 CULLIGAN WAY
(Address) MINNETONKA, MN 55345
(Add(t962) 933 -7200 (City) (Zip Code)
(Contact Person) (Phone)
mit t APPLICANT SIGNATURE � DATE 3 - 1 1- a
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 1 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 $ 06 .0 0 Building Permit #
PLUMBING PERMIT FEE $ 91 .5 0
STATE SURCHARGE $ 5.6 0 40-
TOTAL PERMIT FEE $ 3'1.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
r / Receipt No \.6
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Date 3 / / Z4 j k3 By
Building Official Date / ,y..L.
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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