HomeMy WebLinkAboutPlg Permit 04-0761
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
,l'lease type or print and sign at bottom)
ADDRESS
I. Blue File PERMIT NO 0/ J ,)
; ~~~w ~~~licant . -, - 7~ /
/63R'/
WC7Qd Duck- Tr
ZONING (office use)
LEGAL DESCRIPTION (office use only)
. LOTY"~LOCK 3 ADDITION w~d ~.
OWNER
(Name)
(Address)
PID~- cig;)-IO~f 0
(Phone)
(Phone) (J5 2 ) (;(/1- ljCbo
L efh.u,t tIe Ss-c;c;q
(City) r (Zip Code)
. I . II (phone) (&,17; 2:7/'- 397Y
~( DA~E' L/-z- 2~(/
~~~~ANT Ikc.red; tPC) ~! ~'n~
(Address) 7 -z. ! D 0 ~. \/t e fr--.&J( r r
(Address)
(Contact Person) 10 I"'V\....._ 1-/t;J~
APPLICANT SIGNATURE ~A.-6<
/
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I QU,~ntity
Bath Tub with or without Shower,., I' (f{\:.-'
Dishwasher \cJ'.
Floor Drain ';-,l)v Y ~
Lavatory (Bathroom Sink) 1/ f I/! V .' Q
I Laundry Tray (lor 2 compartment sink :71 . ,(f) 1 '-'
I Shower Stall 1fT) t,l
1 Sinks 1\./
I Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
Rough-ins
Water Heater
I Water Softner
1 Stand Pipe (Washing Machine)
1 Sewage Ejector
1 Backflow Assembly
I Backflow Assembly Test
.x I Lawn Sprinkler
T 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
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Building Permit #
39,St)
.50
$
$
$
~ -
f-I 0.-
Paid I f
c,fO .." ---
Date 7- ;;)-d-l!
ReceiQJ7Lj d r;-
S-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave" S.E., Prior Lake, MN 55372-1714