HomeMy WebLinkAboutPlumbing Permit 13.1373 t
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f e CITY OF PRIOR LAKE PLUMBING PERMIT
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r. Gold Cit PERMIT NO.
3.� App (3°131
3. Yellow Applicant
J; or pm' a and sign at bottom)
ADDRESS ZONING (orrice use)
6 4 ci 5 (.. -t- -, ?c... 9 , o0.,, . E , Pr 1 a c le, , i S 5 7z,
LEGAL DLSCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER p
(Name) -I fie e tt ff
_ ' - k r A._
(Phone)
(Address) i b i C C s , E • fr f) kQ e 5 5 3 -""7 „., APPLICANT
(Name) XA ' C , . 1 1 OUL\ ( OW one) (– 2.a? – e i 5 1 C
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(Address) I t .._ e 0, r w La , - . c7 _ P ca 5 / / '--
(Address) (City) (Zip Code)
(Contact Person) ).. ,. - (Phone) ?G� --L wry ct 29 ,.
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APPLICANT SIGNATURE DATE 2 3
APPLICANT PLEASE COMPLETE BELOW
0 uanti Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
1 0 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 $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ �� w - 2
(office Use duly)
This Apt : ion Becomes Your Building Permit W en pproved Paid Receipt Nori (
0 ,.� i� L – W ' J D ate *� By
Date U L, !Sc., ((3 f i h--
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
dfdf. f,linte C *rPPt C I. Pr;nr I "al". Minnocrtto S{27,