HomeMy WebLinkAboutPlumbing Permit 15. 0942 Z
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Date
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ZE CITY
OF PRIOR LAKE PLUMBING PERMIT
1�N E S
1.
ted rcity ile /S PERMIT NO Q
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
1 yl�C\3 — CCNAA - r br Lcktisz.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(NWN ER l'\ 1,x 1 " V C.,\ACAAA (Phone)"\69— Lt`-c,' 1 -►
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(Address) 140 3 — e(,1,1N.W\ \--WM \U V G,)l /1 V \�� Tb53 1�
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(Name) N � .. II A ! .. . a (Phone)" S�-`ms- ` T��
(Address) �'
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vI 1.6 1 _ 414 S yC& / 1 Y\ N •
P u' 1 a1„) (Address) (City) _ (Zip Code)
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(Contact Person) CW �.\\W�.� lie (PhoneC\ a �`'
APPLICANT SIGNATURE ..mit�/ DATE - k, ` 1 b
APPLICANT/ PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher k 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
Ha SO
Estimated Cost $ -7 % Building Permit#
PLUMBING PERMIT FEE $ Liq SO
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ J o D V
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 57) U Receipt No.,,5 --
Date�Q c By
Building Official
Date C/.- �7, l
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372