HomeMy WebLinkAboutPlumbing Permit 15. 1139 5 ❑ ❑ C) 00000❑ = O Do 20
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/s PRip\ Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File 9
z �,a city PERMIT NO. /6r�'1. �6
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
15DS a.C-(rS PCkss } to e r
LEGAL DESCRIPTION(office use only) r
LO)�I�Q BLOCKODa ADDITION PID p�53�sl�O3(7v,
O(NW e))R 4o ( (Phone) 9S-o --4S6'Y— 137/
(Address) /5-505 O5 JJ "DCI.S S Pi 2)r La. I..SL l i1)Al 55 Q
(Name)APPLICANT ck,rm (Phone) TS-c9-1&-7—(
(Address) (gnubt-4 (3 P31t., ,ev\SV t( l e 1 -11V sG��
(Address) (City) (Zip Code)
arrin (Phone) q a—76 7—(000(Contact Person) �e
APPLICANT SIGNATURE
DATE -1 S— IS
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
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 $ ' �v Building Permit#
PLUMBING PERMIT FEE $ Lvq, so
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ �JO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid l Receipt No. 261
Datey
Building Official Date - j t
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372