HomeMy WebLinkAboutPlumbing Permit 15. 1025 11116 a
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CITY OF PRIOR LAKE PLUMBING PERMIT Date Recd
NNE S°
1.nlue File
2. :ld City I PERMIT NO. 5. / 0 ZSt
(Please type or print and sign at bottom) 3. Yatow applicazn
ADDRESS
h
/4-1 < };�( f '_ ! �- L ZONING(office ase)
LEGAL DESCRIPTION(office use only)
/ —
LOT BLOCK ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
APPLICANT �,; ). ) GG
(Name) , n e:_� i-,,-- ,ti.; , C_ r' C Ce; (Phone) 7`7 2 -7J JJ - 69
/
(Address) Z(-) ‘7f‘
:34.. &) &(-? ' a 7
(Address) r v4' '(City),'��‘: ��' ��lG'�� 71
J (Zip Code)
(Contact Person) _ ri t.,1 , `_' {-• % 'K,�.- t'�
t (Phone) 2- ---)S8---SO 9-S
APPLICANT SIGNATURE - J-k a_ _At --,L- _
DATE 61/2 A 5
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixtureuanti
ty Bath Tub with or without shower Q_ Type of Fixture
Rough-ins
Dishwasher
Floor Drain / Water Heater
Lavatory(Bathroom Sink) Water SoftenerStand
Laundry Tray(1 or 2 compartment sinkPipe(Washing Machine)
Shower Stall Sewage Ejector
Backflow Assembly
Sinks Backflow Assembly Test
Water Closet(Toilet) LaOther
FEE
Industrial,Commercial&Multi-family 1%of job cost with$49.50 DULE
minimum
Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $ /Al. `j0
STATE SURCHARGE $ $1.00
(Office Use Only) TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid 5
t� ceipt No,o..7 1 .�/
Baildin¢Official Date U / cT
Date O , t,I.5-
24
::
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372