HomeMy WebLinkAboutPlg Permit 05-0159
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
3. '- oS-
I. Blue File I PERMIT NO r r
2, Gold City , . O~.' 0/9
3, YeJlow AppliC8llt
(Please tvPe or print and si~ at bottom)
ADDRESS ZONING (office
S 72..1 1'-" bv es ~\ L.. ~ use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER
(Name)
..)~ 1 St<:..bEL
(Phone) 'fs-z..
~O- 74 '=>1
(Address)
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~~~ANT \JCI.:51 'HMM8J1Jls" ~ 1-lJ~
(Address) 3'?u) C::o~
(Address)
. (Phone) CIS?- Q2Q-b7b.7
S'f" . W:M I~ p~ M ~ ..s:sc:i~
(City) 1 (Zip Code)
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, (Contact Person)
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(phone)
Quantity
~ h DATE
(.\P)>LICANt PLEASE COMPLETE .mLOW
Typeof 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)
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APPLICANT SIGNATURE
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Type of Fixture I
Rough-ins I
Water Heater ~ w~11Q2. \.1~
Water Softner
Stand Pipe (Washing Machine)
Sewage Eiector
Backflow Assetnbly
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
Estimated Cost $ Building Permit # tJ.>. () /5"1
PLUMBING PERMIT FEE $ 3''1. S7J
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ Ifo. (/V
(Office Use Only)
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BuUdin!! Official
Date
I Paid +0 . (flJ
I Date "3. I. O~
ReceimNo4Bd23
By fdLR-
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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