HomeMy WebLinkAboutPlumbing Permit 09.1013 •
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.:§V '�=- ' CITY OF PRIOR LAKE PLUMBING PERMIT
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44lNNES6°
I.BlueFile
2.Goldd City PERMIT NO /O
a 3.Yellow Applicant 1 1.3
(Please type or print and sign at bottom)
ADDRESS Zi5NING(office use)
q ) T) nix a--)-,. ,:+) ) s
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ( h
9r52--1-14 7 6_5(Nal �c Ie- t. Ii l' i\'1 -A (Phone)
(Address) '4759I5- r, he,— IPA / l C
APPLICANT
(Name) e ' )v1-EC I I A-A.) +CAL CO • (Phone) 5 2 _7 o Se 95
(Address) 1 C 6,14'
_14' N 4- 1n NI✓c.L,, 1"er tit 566 71
(Address) / (City) , -- (Zip Code)
(Contact Person) A v J y� .3-_ f- -p,� ( A \i %( (Phone) 2_--1'S — kL 9 C
APPLICANT SIGNATURE 'I IA j6 - DATE / /— (U
APPLICANT PLEASE 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 1
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
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $ .1-1q, ()
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ -O.UCi
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid ce pt No.
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Bulldine Official Date Date /2 _7 024 hour notice for all inspections(952)447-9850,fax(952)447-4245 UU
4646 Dakota Street S,E.,Prior Lake,Minnesota 55372