HomeMy WebLinkAboutPlumbing Permit 04-1207
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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ADDRESS
I. Blue File
2. Gofd City
]. Yellow Applicant
I PERMIT NOrJ'I_ /;UJ'()
l&~ 6Cl4-& ~ ~
.
I ZONING (o_use) I
APPUCA.NT-;7
(Name) De<<? ~..w. 1\
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(Address) ;J-ll <6 ( X ~L>;'\
(Address)
(Contact Person) (l"f'\~ I ~-e(ti~
APPLICANT SIGNA~RE /f}/ vi ~
...... /
APPLICANT PLEASE COMPLETE BELOW
Quantity I Type of Fixture Quantity
Bath Tub with or without shower Rough-ins
I Dishwasher I Water Heater
I Floor Drain Water Softner
I Lavatory (Bathroom Sink) ,..stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink .'1 / Sewage Ejector
I Shower Stall \ r V / ~/ Backflow Assembly
I Sinks ^ L., - Backflow Assembly Test
I Bar Sink I llJ \V ( Lawn Sprinkler
I Water Closet (Toilet) II\--' Other
V FEE SCHEDULE
lodustrial. Commercial & Multi-family 1% of job cost with a $39.50 minimum
LEGAL DESCRIPTION (office use only)
LOT BLOCK
x
AUUIIION
OWNER
(Name)
(Address)
t'1 0#"\:'\ G{ <r :r- t'\ c...
.....
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Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Om.e Use Only)
This Application Becomes Your Building Permit When Approved
Building om....
nlte
pm2S--001- ~~-b
(phone)
(phone) <7;;?~ ~ Af'3.). -au.."3"?'
..k~ "./....Y\. <"S25S J-
(City) (Zip Code)
(phone) 9S~ ~ '&60 - ~ l~ '?
DATE J dJ~J/)L/
Type of Fixture
Residential, New One & Two-Family $99.50
Residential, Additioos & Alteratioos $39.50
Building Permit #
$~/.c
$
$
.50
Paid :!:RJc/
DaljJl._i _()tj
Receipt No.
B~
24 hour notice for a1llnspeedo.s (952) 447-9850, fa. (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714