HomeMy WebLinkAboutPlg Permit 04-0031
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec' d
I. z, 0 . 04--
(Please type or print and sign at bottom)
ADDRESS
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1. Blue File PERMIT NO 4
2. Gold City . 0 0 O? I
3 Yellow Applicant ~
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT vi BLOCK ( ADDITION Ii) ./j;~ t 1 tr9;(t/
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(Address) ,L\ \ 0 D -t4+\F+~ 1cL\21 C~'R.
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(Address)
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I rlPPLICANT SIGNATURE/I;m
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(City) (Zip Code)
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(Phone)
DATE
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Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
/
Type of Fixture
~OUg -ins
eater
e 6er
,p~tan '{l~Washing Machine)
ge Ejector
ackflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # ()t!-. () ()1 /
(5), :JU
.50
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$
$
$
Estimated Cost $
lice Use Only)
fhis Application Becomes Your Building Permit When Approved
Paid
, Receipt No.
Date
By
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714