HomeMy WebLinkAboutPlumbing Permit 15. 1081 O
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CITY OF PRIOR LAKE PLUMBING PERMIT
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I.Blue File PERMIT NO./5_1081
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3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
b Fa) e- )CA__ _ .\,131W A 0_ .\V al a/O
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) \-. 0\A3 Y\.C.) Q 1(N (Phone) \a—a } --
(Address) -F3 <��j\cUv�1`! ) ) Px-vQ),T l 5 )_-5 -1-- ._
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APPLIC' ik t ` t o
(Name) \ I_. .. lv A 1 L .. c lk�. °� .,. (Phone)5 `y(„t��t.�l`t
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(Address) _ )< • L � >,+�� �� � '�
(Address) (City) (Zip Code) _
(Contact Person) \ .0t.(_)1/4—___ (Phone) CA... ..JC,
APPLICANT SIGNATU"Iline. _ _ __�\ ►<.!"AO 1, li iTE
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APPLICAN 'LEASE 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
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Estimated Cost $ OCC,.) Building Permit#
PLUMBING PERMIT FEE $ CI 6Q
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ -00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 56..s„---0 jj,tNo.Date 9 is—•L/S^ ; %�/
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372