HomeMy WebLinkAboutPlumbing Permit#09-0934 Date Rec'd
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,� � CITY OF PRIOR LAKE PLUMBING PERMIT %Z _ 9, U
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3. Yellow Applicant
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ADDRESS ZONING (ofl['ice use)
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LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION P�
�aWNER �2l%t��� /`�/����/c_.. (Phone) �7- �¢ �J � `7�
(Address)
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(Address) (City) (Zip Code)
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APPLICANT SIGNATURE
DATE � 2 r / y /p 9
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fiacture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet � Other
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FEESCHEDULE
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 $ �i er�.p���; P�RMIT
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt N
Date � 9� G By
BuIIdin¢ Official Date
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372