HomeMy WebLinkAboutPlumbing Permit 15. 0490 0
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CITY OF PRIOR LAKE PLUMBING PERMIT Date Recd
4lrsa*
z:cola e:tylicantPERMIT NO.j5-, 4�0
(Please type or print and sign at bottom) 3. Yellow App
ADDRESS
/& 8V A I1 mom Atte'
S r 553-7
53-7 a ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION /VOlASvl L P APA
OWNER �
(NaMOtS1 t eit.L.S /�
(Phone) `75 44 7" 96,
(Address) 16,181 F,llrvtore, S z �r� take 5 5 3 7a
APPLICANT / /�J �J
(Name) " ' YYY'0J2<'Q ( _.Gl?K.P ' .on,S (Phone) g 5a - 445- 48-o3
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(Address) 6a-&5a C w � 81 i d cSr P _ 6 53-7
n
(Address) i� < 7
�`. �� ( tn') (Zip Code)
(Contact Person) JO •
`p� / (Phone)
APPLICANT SIGNATURE
L�A . I Ii � DATE n/1 1//
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture
Quantity Type of Fixture
Bath Tub with or without shower
Dishwasher Rough-ins
Floor Drain Water Heater
/ Water Softener
Lavatory(Bathroom Sink)
Laundry Tray(1 or 2 compartment sink StandPipe(Washing Machine)
Shower Stall Sewage
Ejector
Sinks Backflow Assembly
Bar Sink Backflow Assembly Test
Water Closet(Toilet) Other
FIndustrial,Commercial&Multi-family 1%of job cost with$49. 50 minimumE UE
Residential,New One&Two-Family $149.50
// /� Residential,Additions&Alterations $49.50
Estimated Cost $ (?Dd D v Building Permit#
PLUMBING PERMIT FEE $ 64.00
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
� � g7) Receipt No.
is q• ‘.
BuildDate
Buntline Official Date l / By
S
24 hour notice for all inspections(952)447-9850,Tax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372