HomeMy WebLinkAboutPlumbing Permit 09.0161 •
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CITY OF PRIOR LAKE PLUMBING PERMIT
0�'NNESO`°*
2. Bluelcity PERMIT NO.
print and sign3.Yellow Applicant
(Please type orV�-4/
at bottom)
ADDRESS ZONING(orrice use)
(977G Lie s--1✓r1 X.c, S ,-..--
LEGAL
-.iLEGAL.DESCRIPTION(office use only)
LOT BLOCK ADDITION P11)
OWNER a pQ ( / q _ ll
(Name) yr , C. a►� �i�'C z IN (Phone) ! s d-' ad-(,- ( d 1 S
(Address) 5 a — —
APPLICANT
(Name) S w "--- (Phone) 5 4r^"sr--_
(Address) S'.,,-.--0 P. z-- S'' s-3 7 LL
(Address) (City) (Zip Code)
(Contact Person) - '0.M-'--. / (Phone) S ci rw"---
APPLICANT SIGNATURE 4 DATE 4 44 to
1
mi
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 I 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
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $ 19
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ J7L.0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 54.13
.3-a d Q Receipt No /v 2
1 i!•�n �� 121 Q
l ill-1
undine Official Date
24 hour notice for all inspections(952)447-9850,Date fax(952)447-4245 By
y i,,.(�
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372